September is National Atrial Fibrillation Awareness Month. If you’re like most Americans, you have no idea what atrial fibrillation is or how to identify it. A 2014 survey showed that fewer than 20 percent of people could, “correctly identify medical conditions such as sleep apnea and diabetes as risk factors for atrial fibrillation.” The average person with atrial fibrillation, or AFib, is five times more likely to suffer a stroke than someone with a regular heartbeat. This month, Capital Cardiology Associates is proud to team up with CBS 6 News – WRGB Albany, on educating the Capital Region on the most common type of heartbeat abnormality that affects more than three million people in the United States: atrial fibrillation.
What is Atrial Fibrillation (AFib)?
“Atrial fibrillation is the most common abnormality that we experience in cardiology,” says Dr. Lance Sullenberger, board certified cardiologist at Capital Cardiology Associates. The American College of Cardiology describes AFib as, “the most common heart rhythm disorder (arrhythmia).” AFib is an irregular heartbeat that breaks down into two main types:
- Valvular AFib refers to atrial fibrillation that is caused by a heart valve problem. Examples of a heart valve problem include a narrow or leaking valve, or a valve repair or replacement.
- Non-valvular AFib (sometimes called NVAF) refers to atrial fibrillation that is not caused by a heart valve problem. Non-valvular atrial fibrillation is the most common type of AFib.
While treatment options may be different for non-valvular and valvular atrial fibrillation, the effects of the disease are often the same. AFib sets off a chain reaction: your heart isn’t beating normally which causes your blood to stop moving or flowing well, increasing your risk of heart failure. Because blood isn’t pumped out of the heart normally, it’s easier for blood cells to stick together and form clots which can increase the risk of heart failure, heart attack, or stroke if they travel to another part of your body and cut off blood supply to the brain.
AFib has several causes: heart disease, high blood pressure, heart defects from birth, sleep apnea, certain medicines, heavy alcohol or caffeine consumption, drug use and smoking. If you have a family history of heart disease, heart attack, or stroke you are at a greater risk of atrial fibrillation.
AFib is a major health problem, in that, it also makes blood clots in the heart that can travel and can cause a stroke or block flow to other critical organs.
The Mayo Clinic reports that more than 200,000 AFib cases are diagnosed per year in the United States. Typically at the age of 65, adults are at a greater risk of abnormal heart rhythms, although many AFib cases are being diagnosed younger in life, some as young as 40 years old. Dr. Sullenberger pointed out that, “the problem with atrial fibrillation, not only is that it can cause symptoms, it is a major risk factor for stroke within the United States. When we see a patient with AFib, we have to make a determination whether that patients risk of stroke merits them being on blood thinner medications, some of which you see advertised on TV.”
The most common symptom of AFib is an irregular heartbeat or palpitations. Dr. Sullenberger describes a thumping or racing heart, some patients experience fluttering or feeling like their heart is skipping a beat. Other common symptoms are shortness of breath, dizziness or light-headedness, and fatigue. If you experience these symptoms, contact your doctor immediately. “Everyday I see patients who have heart palpitations,” notes Sullenberger. “What we are really trying to determine when we see a patient with palpitation is: do they have atrial fibrillation?”
Sometimes AFib doesn’t present or cause any symptoms. This is why September has been designated as National Atrial Fibrillation Awareness Month. Heart disease is often looked as condition that happens to older adults or seniors. This is not the case. A 2015 study published in the European Heart Journal illustrates how atrial fibrillation progresses over time. The study noted that Larry Bird, Tony Blair, and Mother Teresa all suffered from atrial fibrillation. In adults under the age of 50, certain lifestyle factors such as alcohol consumption and smoking can trigger an AFib episode in addition to hypertension, hyperthyroidism, or valvular heart disease.
'Men and women, as young as in your twenties, you should be thinking, ‘What can I change now to start preventing future problems?’ We were all in our 20’s once, 66 seems a long ways a way but 40 is not that far. We see plenty of patients with heart attacks and strokes from patients in their 40’s.' - Dr. Lance Sullenberger, Board Certified in Internal Medicine, Cardiovascular Disease, and Advanced Heart Failure/Transplant Cardiology, Capital Cardiology Associate
Dr. Sullenberger explains AFib as, “when the top chambers of the heart go electrically haywire. They are firing a bunch of electrical signals to the bottom chamber which controls the pulse. The bottom chambers then start beating irregularly.” To investigate your heart’s electrical activity, your doctor will order a series of cardiac tests. The first would be an electrocardiogram (ECG). “It is a simple ‘first step’ tool to help your doctor increase or decrease his or her suspicion that your symptom is or is not related to your heart,” says Sullenberger. During an ECG electrodes are placed on your chest, arms, and legs to detect the electrical waves your heart makes. It usually takes about five to ten minutes to complete the test.
There are some special medical diagnostic devices that your doctor may have you wear to record your heart activity. “A Holter Monitor is an external unit that is worn for 24 to 48 hours,” shares Maryellen King, Advanced Practice Nurse at Capital Cardiology Associates. “While you are wearing it, the device records heart rhythm data. If there are changes in the rhythm we will see it. It’s a way for use to identify patterns that wouldn’t show up on ‘snap shot’ EKG that we would take in the office. It’s the first step in more longer cardiac monitoring that we use.”
The good news is that with proper treatment, you can live a full life with AFib. There are different treatment options that depend on your age, symptoms and frequency of episodes, whether your heart rate is under control, your risk of stroke, other medical conditions (for example, if you already have heart disease). Your doctor will prescribe your treatment that will focus on lifestyle changes and therapies to prevent blood clots, heart failure, and stroke.
Lifestyle changes will most likely include:
- If you smoke, quitting
- Getting regular physical activity and exercise
- Eating a heart healthy diet (like the Mediterranean Diet) that is low in fat and salt
- Maintaining a healthy weight with regular doctor check-ups
Your doctor also has some medication options. You could be prescribed a blood thinner/anticoagulant that you have seen in advertising. The blood thinner warfarin (also known as Coumadin®) has been around for more than 60 years. There are also several newer blood thinners available now, including Eliquis® (apixaban), Pradaxa® (dabigatran), Xarelto® (rivaroxaban), and Savaysa® (edoxaban).
For some patients, implants could be an alternative to the lifelong use of blood thinners. Some people with atrial fibrillation who should take warfarin or another anticoagulant to reduce their stroke risk can’t due to their lifestyle or health history. Other AFib patients choose not to take anticoagulants, or blood thinners, due to side effects or for other reasons. Like warfarin, a common blood thinner, WATCHMAN can effectively reduce stroke risk. This permanent implant is for people with AFib not caused by a heart valve problem who need an alternative to warfarin, or a warfarin substitute.
Left atrial appendage closure: A procedure called left atrial appendage closure provides an alternative to warfarin for people who need one. The left atrial appendage is a small pouch at the top of the heart. When a blood clot escapes from the left atrial appendage and travels to another part of the body, it can cut off the blood supply to the brain, causing a stroke. In people with AFib not caused by a heart valve problem, more than 90% of stroke-causing clots that come from the heart are formed in the left atrial appendage (LAA). Closing off the LAA is an effective way to reduce stroke risk in these people.
Every person with atrial fibrillation has different needs. If you’ve been diagnosed with AFib, talk to your doctor about the AFib treatment options available to you. Your doctor will help you understand the risks and benefits associated with each option. Together you can choose the treatment that is right for you.
September is National Atrial Fibrillation Awareness Month. If you have a family history of heart disease or have questions about your risk of heart disease, stroke, or heart attack — talk with your doctor. “The first person to talk with is your primary care physician,” points out Sullenberger. “Address what your concerns are. You are much better off finding things that can be changed before they become life altering than having that problem develop into an emergency room visit or hospital stay that could have been prevented.”
Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. For more information, contact the experts at Capital Cardiology Associates at 518-292-6000 or at www.capitalcardiology.com.