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Atrial Fibrillation, My Story

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I was recently diagnosed with Atrial Fibrillation (AFib). It, like most other illnesses we seem to be contracting these days, comes with outcomes that even the best doctors describe as “unpredictable”. They are uncertain, it seems, why I had this first bout, except to say that given my chronic heart disease it’s not unexpected that I might suffer from Atrial Fibrillation. 

Okay, but they can’t say why with any certainty why the attack occurred when it did or as it did. My heart, they say, is fine. No real damage evident despite three heart attacks. The arteries are not what they should be, I get that, but my heart, according to the doctors is pumping just fine. 

 

So why was I simply sitting on my couch, not exerting myself, just watching television and felt my heart racing at break-neck speeds? I was out of breath from just walking through the house and for the better part of two weeks I was fatigued beyond my normal level

Baffled and quite frankly, afraid, I called a friend who took me to the hospital where they found my heart rate off the charts one moment and then “normal” the next. Classic Atrial Fibrillation. My wife was out of town visiting her daughter and I hadn’t built up the nerve to ruin her vacation. I thought I’d wait until I knew exactly what the problem was and hopefully I’d be able to reassure her that all was under control…no need for her to panic.

They hooked me up to all of the fancy, smart hospital machines and gadgets, took my blood pressure, temperature and oxygen levels ad nauseum and then determined that I needed to be admitted. That came with a warning that they would probably be shocking my heart back into rhythm the next day to slow my runaway ticker or reset my heart’s rhythm - a procedure known as “electrical cardioversion”.

Through the night the mini exams continued. Blood pressure checks, temperature checks, oxygen counts. Don’t get me wrong, I understood what they were attempting to do and I appreciated the attention they were showing me. By morning they seemed to be hedging on whether the shock treatment was needed. It appeared that my heart rate was adjusting either automatically or from the treatment they administered. 

I could, at that point call my wife and let her know that there really was no reason to panic, that I was back to my “normal” self and that they expected to release me from the hospital that day. Fine and dandy, I thought. 

But I left the hospital with huge questions still dangling over my head…why did this occur? Did what they did in the hospital really resolve the issue or could it reoccur? Those questions plague me still today, more than a month after the diagnosis.

That seems to be the hallmark of AFib, as it’s called colloquially. The ailment is riddled with uncertainty even for the doctors who treat it. The cardiologists have an air of nonchalance about them that for most patients is at best, off-putting. 

On one hand you get that AFib is a serious, life-threatening condition that has to be treated with great care and on the other hand you feel like everyone is moving slowly when you think they should be in “code red” status. Your heart is broken or even worse, exploding! You don’t really know what’s happening. But the sense of urgency just isn’t there it seems. Ugh!

What I have done to try to ease some of my anxiety over my Atrial Fibrillation is to read all I can about the illness. I try to understand what it is and why it occurs. And more specifically, why I came to suffer from it and if there is anything I can do to avoid future bouts.

As fearful as I was that what was happening to me both before and after I went to the hospital that day would lead to “the big one”, I had to face what I was up against and get the necessary treatment. After five stents one thinks the next and only step is a drastic procedure like the insertion of a pacemaker or even more severe, open heart surgery.

But there are a number of steps that can be taken, depending on a patient’s condition, before either of these dramatic measures is taken.

There is reassurance in research and WebMD is a great resource for information on all things health. No difference with AFib.

Here’s what I found on the pages of WebMD:

What is atrial fibrillation?

Atrial fibrillation (say "AY-tree-uhl fih-bruh-LAY-shun") is the most common type of irregular heartbeat (arrhythmia).

Normally, the heart beats in a strong, steady rhythm. In atrial fibrillation, a problem with the heart's electrical system causes the two upper parts of the heart, the atria, to quiver, or fibrillate. 

The quivering upsets the normal rhythm between the atria and the lower parts of the heart, the ventricles. And the ventricles may beat fast and without a regular rhythm.

This is dangerous because if the heartbeat isn't strong and steady, blood can collect, or pool, in the atria. And pooled blood is more likely to form clots. Clots can travel to the brain, block blood flow, and cause a stroke. 

Atrial fibrillation can also lead to heart failure.

What causes atrial fibrillation?

Conditions that damage or strain the heart commonly cause atrial fibrillation. These include:

  • High blood pressure.
  • Coronary artery disease.
  • Heart attack.
  • Heart valve disease. 

Other possible causes include:

  • Other medical problems, such as heart failure, lung disease, pneumonia, or a high thyroid level. 
  • Heart surgery.
  • Heavy alcohol use. This includes having more than 3 drinks a day over many years as well as drinking a large amount of alcohol at one time (binge drinking).
  • Use of stimulants. These include caffeine, nicotine, medicines such as decongestants, and illegal drugs such as cocaine.
  • Use of some prescription medicines, such as albuterol or theophylline.

Sometimes doctors can't find the cause. Doctors call this lone atrial fibrillation. 

What are the symptoms?

Symptoms may include:

  • Feeling dizzy or lightheaded.
  • Feeling out of breath.
  • Feeling weak and tired.
  • Feeling like the heart is fluttering, racing, or pounding (palpitations).
  • Feeling like the heart is beating unevenly.
  • Having chest pain (angina).
  • Fainting.

Sometimes atrial fibrillation doesn't cause obvious symptoms. 

If you have symptoms, see your doctor. Finding and treating atrial fibrillation right away can help you avoid serious problems.

How to Treat Atrial Fibrillation

Aspirin for AFib

When you have atrial fibrillation, your heartbeat is irregular. Blood doesn't flow as efficiently as it should and clots may form in your heart. If a clot travels to your brain, it can cause a stroke. Many people with AFib are more likely to have strokes. Aspirin may be recommended for some people with AFib who aren't treated with other blood thinners. Side effects from aspirin or blood thinners can include nosebleeds to ulcers, so talk to your doctor first.

Warfarin for AFib

If you have AFib your doctor will probably prescribe a more powerful blood thinner called an anticoagulant, especially if you have high blood pressure, diabetes, or heart failure. The most common is warfarin (Coumadin). Warfarin can often cut your risk of stroke, but requires close monitoring. 

You’ll need frequent blood tests and will have to be careful to avoid heavy bleeding from cuts or other injuries. Your doctor will also talk to you about certain foods that interact with warfarin.

New Blood Thinners

Recently, the FDA approved new anticoagulants to treat AFib not caused by a heart valve problem. These medications reduce the risk of stroke. You don’t have to have regular blood tests. Plus, these new medicines don’t interact with foods. As with other anticoagulant medication, there's a chance you’ll have problems with bleeding.

Slow Down Your Racing Heart

If your heart is racing, medicine can slow it down and decrease the strain on your heart muscle. Slowing it below 100 beats per minute can help you feel stronger. Doctors often prescribe either beta-blockers or calcium channel blockers, depending on your health.

Reset an Irregular Heart Rhythm

In some people with AFib, electrical cardioversion may be recommended to "reset" your heart’s rhythm. Using mild anesthesia, a doctor uses patches or paddles to gently shock the heart. You may need ultrasound first to check for clots in your heart. If there is a clot, you’ll take blood thinners for a few weeks before your procedure.

Heart Reset With Antiarrhythmics

Electrical cardioversion often works to restore a regular heart rhythm, but about half of people get AFib again. So medications called "antiarrhythmics" are sometimes used to help keep the heartbeat regular. With these, you'll need close monitoring. They can have various side effects including heart rhythm problems.

Ablation for AFib

If drugs and electrical treatments aren’t working, your doctor may suggest a procedure called ablation. While you're sedated, a thin, flexible tube is inserted into a blood vessel and guided to the spot in your heart that is misfiring. The surgeon then destroys the tissue area by heating or freezing it. Depending on your treatment type, you may need a pacemaker, too.

Pacemaker for Steady Beat

If your heart beats too slowly, you may need a pacemaker. This small, battery-powered device is implanted near your collarbone, with wires leading to your heart. After surgery, you’ll need to avoid pulling on the area, but soon you may be able to go back to normal activities. Most electronics like microwaves or phones won’t interfere with your pacemaker, but some security systems and headphones can. You’ll learn what to avoid and how to check your own pulse.

Heart Surgery for AFib

If medication and simpler procedures haven't helped your AFib, or if you have certain other heart problems, your doctor may recommend an operation called a Maze procedure. The surgeon makes precise cuts or scars on the heart's upper chambers to interrupt the electrical signals that throw off your heart rhythm. 

Sometimes this can be done with only a tiny "keyhole" incision. If the surgery works, people with AFib may have fewer symptoms and can usually do all normal activities.

Lifestyle Changes for AFib

No matter how you treat your AFib, there are lifestyle changes you can make to help your heart. Eat a heart-healthy diet. Cut back on the caffeine you drink. Some people find that coffee, sodas, and tea can make their symptoms worse. Read medicine labels to check for decongestants -- especially in cold and cough medicines. Limit alcohol to no more than 1 to 2 drinks a day. If you smoke, quit. Talk to your doctor if your symptoms get worse.

   

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Eric Von is a former radio talk show host and a publisher of Brain Brawn & Body (brainbrawnbody.com). You can contact Eric at eric.von@brainbrawnbody.com.

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Guest Sunday, 30 April 2017