Atrial fibrillation is a cardiac condition in which the atria (the upper chambers of the heart) beat rapidly and irregularly. Patients with this condition are at an increased risk of strokes, blood clots, and heart failure. High blood pressure, sleep apnea, lung disease, metabolic syndrome, and diabetes can elevate a patient's chances of developing atrial fibrillation, and obese individuals are at a higher risk too. Some patients may have episodes of atrial fibrillation that occur intermittently. For others, the condition could persist for months, and some individuals have permanent atrial fibrillation. To diagnose this condition, doctors start by listening to the patient's heart with a stethoscope. This helps doctors understand whether the rhythm of the patient's heart is normal.
Based on information from the physical exam, the doctor might decide to order further tests. An electrocardiogram is the primary tool used in the diagnosis of atrial fibrillation, and doctors might also recommend an echocardiogram, Holter monitor, event recorder, or stress test. Treatment options for this condition include electrical cardioversion, cardioversion with medication, and catheter ablation. Many patients also take medications such as dofetilide and amiodarone to help the heart maintain a regular rhythm and prevent future episodes.
Some patients with atrial fibrillation may experience chest pain. The pain is typically located in the middle of the chest, and it can be intermittent. Since chest pain is also a symptom of a heart attack, patients who have this symptom should seek emergency medical care if it persists for more than a few minutes. Seeking treatment is especially important if the pain radiates to the jaw, back, neck, arms, or stomach. To determine the underlying cause of chest pain, doctors will place the patient on a heart monitor.
Blood tests will be performed to check for specific markers of cardiac damage, and medical staff may also need to do echocardiograms or other diagnostic procedures. If atrial fibrillation is diagnosed, patients may be given medication, and immediate treatment may be required in serious cases. Patients should always let their cardiologist or primary care doctor know if they experience chest pain regularly. It can be helpful to make notes about whether the pain is sharp or dull, and the patient might want to note what they were doing when the pain occurred.
Heart palpitations occur when the patient senses their heart is racing or beating in an irregular rhythm. Some individuals describe the sensation as a 'flip flop' in the chest, and it can be both uncomfortable and frightening. While heart palpitations are normally harmless, they may be an indication of atrial fibrillation or another underlying heart condition. Patients with heart palpitations should have a physical examination and other tests to determine the underlying cause.
The doctor will ask the patient whether the palpitations occur at rest or during activity, and they will also want to know if they begin or end abruptly. Letting the doctor know about any skipped beats or fluttering may help with the diagnosis. Patients who have already been diagnosed with atrial fibrillation should alert their cardiologist if they experience new palpitations. The cardiologist may want to review the patient's medications and make adjustments or additions to improve symptom management.
Lightheadedness And Dizziness
Atrial fibrillation prevents the lower chambers of the heart from filling completely, and this reduces the amount of blood pumped to the lungs and rest of the body. Patients may develop low blood pressure and many experience lightheadedness and dizziness as a result. Patients may feel as though they are about to faint, and some have fainting episodes. Individuals who feel lightheaded or dizzy should try to sit or lie down as soon as possible to reduce the risk of a fall. If a home blood pressure monitor is available, it can be beneficial to measure the patient's blood pressure at the time dizziness is experienced. Patients should report any episodes of dizziness to their medical team, and they should let their healthcare providers know if they are experiencing more frequent dizziness than usual.
Fatigue And Weakness
Since atrial fibrillation affects the blood supply to the body, many patients notice fatigue and weakness. In fact, fatigue is the most common symptom of this condition. Fatigue can lead to a reduced ability to exercise, and patients may become very tired after only a small amount of physical activity. In some cases, fatigue could be severe enough to impact a patient's ability to perform daily tasks like cooking or shopping. Patients who are feeling weak or fatigued should try to build in rest breaks throughout the day, and they should ensure they get sufficient sleep.
It can be helpful to cut down on activities, and patients might need to adopt a modified exercise plan. Fatigue and weakness should always be mentioned to the patient's doctor. These symptoms could be signs of other underlying conditions, and worsening fatigue and weakness may indicate the patient's atrial fibrillation is not as controlled as it could be. Doctors may be able to recommend lifestyle changes and medications to improve the patient's symptom control and quality of life.
Shortness Of Breath
The shortness of breath associated with atrial fibrillation occurs most frequently when the patient is lying down. Patients may feel as though they cannot get enough air. To evaluate shortness of breath, doctors will listen to the patient's breathing with a stethoscope, and the patient might also need to have lung function tests, echocardiograms, blood tests, or scans of the chest. Patients with atrial fibrillation should inform their doctor about any increase or change in their shortness of breath, and they may want to ask for advice about activities to avoid and ways to minimize this symptom. Since shortness of breath can be a sign of a heart attack, patients who experience this symptom in conjunction with chest pain or nausea should seek emergency medical care.
Exercise intolerance is a term used to describe when an individual is unable or has a decreased ability to perform physical activities and exercises at the same duration and intensity level as someone of the same age. An individual who has exercise intolerance may experience vomiting, nausea, unusually severe post-exercise pain, fatigue, and other adverse effects. When a healthy individual exercises, their heart rate increases to a rate considered healthy and does not cause them to feel any adverse side effects.
When the heart beats too fast in a patient who has atrial fibrillation, the blood cannot flow throughout the heart normally because the atria do not contract in proper coordination with the ventricles. An individual who has atrial fibrillation may experience a racing heart that causes a rapid decrease in blood pressure, resulting in other symptoms, including feeling dizzy and lightheaded. An individual who has atrial fibrillation may also experience chest pain when they are performing physical activities and or exercising.
Issues With Concentration
The mechanism behind how atrial fibrillation causes cognitive impairment like issues with concentration is complex. The upper chamber of the heart beats chaotically and out of sync with the rest of the heart, allowing blood to swirl and pool up inappropriately in the atria. This pooling of blood can allow for small blood clots to develop, which can enter circulation outside of the heart and cause complications.
Cognitive impairment occurs when one or more of these small clots become lodged in a blood vessel in the patient's brain, producing an obstruction in the affected area of the brain. The obstruction produces what is called a silent stroke, which occurs repeatedly and gradually damages the brain tissue. When the part of the brain that dictates an individual's focus and concentration is affected by this process, it can cause them to lose their ability to remain attentive to certain tasks and in certain situations.
An individual with anxiety can develop atrial fibrillation as a complication of their disorder as a result of a few different mechanisms. Patients affected by anxiety have a hyperactive renin-angiotensin-aldosterone system and an overstimulated hypothalamic-pituitary-adrenal axis, which can cause them to develop fibrosis in the heart tissues. Fibrosis can interrupt the way the electrical signals responsible for producing the heartbeat and rhythm move through the heart, causing an arrhythmia such as atrial fibrillation.
Anxiety is closely related to how well a patient's atrial fibrillation treatment works to alleviate their symptoms. An individual affected by anxiety and atrial fibrillation may not experience the same efficacy from their treatment as someone being treated for atrial fibrillation that is not affected by anxiety. Studies have proven patients affected by atrial fibrillation are more likely to be affected by anxiety than those who do not have this arrhythmia.
An individual who experiences increased sweating, particularly at night, may have atrial fibrillation as the underlying cause of their symptoms. A healthy individual experiences sweating when they are engaging in physical activity or exercise because the rate of their heart increases with their level of activity. Atrial fibrillation patients can experience a high heart rate when they are at rest or even when sleeping at night. The abnormal high heart rate is the result of the chaotic beating of the upper chambers or atria of the heart when they are out of sync with the ventricles.
The increased heart rate means the cells in the heart are working harder than they would when the heart beats at a normal rate. When the cells in the heart are working harder, they are using up more energy at a faster rate than they would in a restful state. When calories are burned by the muscle cells of the heart when using up energy, heat is produced as a byproduct of the process. The body becomes warmer than usual when the heart is under an excessive workload, which triggers sweating.
When the heart experiences atrial fibrillation episodes repeatedly over time, it can become weakened by the excessive workload and burden it has been under. When the patient's heart becomes weak enough to where it cannot pump enough blood to meet the demand of their body, it means the muscle is beginning to fail. When the heart fails, blood is unable to move against the force of gravity back to the heart as well as it would be able to otherwise.
When the blood cannot circulate efficiently because the heart is not pumping it well enough, it begins to pool in the lower extremities of the patient's body. The accumulation of blood in the feet and lower legs causes excess fluid in the blood to be forced through the walls of the veins when they meet their maximum expansion threshold. The fluid forced from the veins accumulates in the nearby tissues and produces swelling in the feet and lower legs.