What You Need To Know About Atrial Fibrillation (Afib / AF)

February 4, 2021 | Written By: Lingheswaran Muniandy

Rate of atrial fibrillation among Malaysian is 0.54% compared to the global incidence rate at 1% according to a cohort study of Malaysian cardiologists.

Before studying atrial fibrillation, firstly you need to identify the branch of the electrical impulse system in the heart. Our heart is divided into 4 chambers, 2 known as the atrium and the other two known as the ventricles. The electrical impulse will start at the "sinoatrial node" located in the corner of the right atrium. Then, these impulses will be transmitted to the muscles in the atrium and ventricles to begin beating.

Atrial fibrillation occurs when these electrical signal channels become abnormal which causes the heart space not to contract and beats normally. In this case, the atrial space can beat at a rate of 4 times more than the normal heart rate.


5 Types of atrial fibrillation

1. "First episode" - Occurrence of atrial fibrillation for the first time and diagnosed by electrocardiogram (ECG).

2. "Paroxysmal atrial fibrillation" - The occurrence of atrial fibrillation is more than two episodes but returns to normal in less than 7 days.

3. "Persistent atrial fibrillation" - Occurrence of atrial fibrillation beyond the day and requires medical or cardioversion intervention.

4. "Long-standing persistent atrial fibrillation" - This occurrence of tachyarrhythmia that lasts more than a year.

5. Permanent atrial fibrillation - A condition in which doctors decide to stop intervening due to high risk instead of treating this problem. 

Atrial fibrillation risk factors

#Age

Age over 60 is the main and most common risk among atrial fibrillation patients.

#High blood Pressure

High blood pressure often forces the heart to change its anatomical structure to accommodate the high pressure. This changes causes the onset of electrical impulses from more than one starting point.

#Coronary artery disease

Obstruction inside the artery will block the blood supply to certain areas of the cardiac muscle. This area will form scars and lead to structural changes.

#Heart valve disease

Valves that are too loose or tight can change the blood pressure in the heart leading to changes in the structure of the chambers in the heart. Then lead to atrial fibrillation.

#Thyroid disease

Thyroid is a gland in the neck that serves to regulate the body's metabolism and blood pressure. Problems with this gland such as overactive thyroid can cause atrial fibrillation.

#Chronic lung disease

Diseases such as COPD and asthma can cause high blood pressure in the lungs which can affect the changes in the structure of the heart chamber.

#The use of alcohol or stimulants

Alcohol and stimulants can increase the body's metabolism and blood pressure in the heart thus changing the anatomical structure of the heart chamber.

#Diabetes

Diabetes is one of the major risks for coronary artery disease that can cause obstructed arteries and damage the heart muscles.

Symptoms of atrial fibrillation

Not all atrial fibrillation patients will experience classic and similar symptoms like others. The symptoms of this disease vary based on the risk factors and the causes. Among the common symptoms reported by patients which have atrial fibrillation are as follows:

  • Lack of energy. Most patients will feel tired to do daily work compared to the previous situation.

  • Heart palpitations. You may feel your heartbeat pounding or more aware of your heartbeat.

  • Shortness of breath. Your heart can become weak as a result of prolonged atrial fibrillation and lead to shortness of breath.

  • Dizziness or lightheadedness. These symptoms are often felt due to lack of blood to the brain due to uneven heartbeat.

  • Chest pain. Although this symptom is less experienced by atrial fibrillation patients, they may be a sign that you have serious heart disease.

How is the diagnosis of atrial fibrillation implemented ?

There are various ways to investigate and make a diagnosis of atrial fibrillation. Among them are;

1. Electrocardiogram (ECG). The wires will be attached over the chest, arms and legs to record cardiac activity for a few minutes. Recorded cardiac activity will show a classic pattern of atrial fibrillation ecg.

2. Holter machine. For patients with atrial fibrillation and cannot be recorded on an EKG, a Holter machine will be installed on the patient for several days to a week.

3. Echocardiogram. This cardiac imaging technique is used to record the activity of the heart and valves as well as identify the causes and complications of atrial fibrillation.

4. Supportive blood tests. Other blood tests such as thyroid gland function and electrolytes.

Treatment of atrial fibrillation

Unstable patients

Stable patients

Description: Unstable patients are patients who experience symptoms such as unconsciousness, confusion, chest pain and shortness of breath.

Description: Patients who do not experience symptoms like unstable patients.

Treatment: For these patients, cardioversion treatment will be given to change the heart rhythm to normal by using "patches" or "paddles" with an energy rate of 100 to 150 Joules.

Treatment: Stable patients will be given medical treatment such as amiodarone, beta blocker and calcium channel blocker depending on the profile and duration of atrial fibrillation.

Once the heart rhythm has been restored to normal, the patient will be evaluated using several scoring systems to start the patient with anticoagulants.

Usually, anticoagulants will be started to prevent the clotting of blood clots in the heart chamber which can lead to various complications that will be discussed below. Once anticoagulants treatment is started, patients will be monitored closely in clinics or hospitals for any risk of bleeding.

Complications of atrial fibrillation

  • Atrial fibrillation and stroke . Blood clots forming in the heart chamber due to atrial fibrillation can be carried to the brain through the carotid blood vessels. When this blood clot reaches the brain, it can obstruct main arteries in the brain that cause stroke.

  • Vascular disease. Formation of the blood clots can also be carried to the blood vessels in the hands and feet. Then lead to obstructed arteries. If leave it untreated, patients are more likely to have muscle and other tissue damage.

  • Weak heart. Due to the rapid heart rate reaching 300, the heart had to work harder to pump blood out. Eventually, the heart can no longer pump properly.

  • Heart valve disease. A heart that beats at an uneven rate and speed can change the anatomical structure of the heart. Later on, the heart valve will be loose and damaged.

Conclusions 

Atrial fibrillation is a common form of tachyarrhythmia other than atrial flutter by patients over the age of 60 and has other risk factors such as high blood pressure, diabetes, thyroid disease, and weak heart. Among the classical symptoms are heart palpitations, shortness of breath and feeling tired. Atrial fibrillation is usually investigated using ecg and other blood tests to identify the cause.

This condition should undergo therapy immediately and be monitored later at the clinic or hospital to avoid complications such as stroke or vascular disease.





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