I was diagnosed with "Atrial fibrillation". Symptoms appear in about 4-5 days, but for a short time. I also feel a heaviness in the heart area. I am asking for a competent and accessible answer to my question: What actually is atrial fibrillation and what causes it? Do I need to take medication for this condition?
We asked Assoc. Dr. Elina Trendafilova, head of the Department of Intensive and Emergency Cardiology at the National Cardiology Hospital - Sofia, for an answer.
Prof. Trendafilova, what is the diagnosis "Atrial fibrillation"?
- Atrial fibrillation is the most common and persistent arrhythmia. It is expressed in arrhythmic contractions of the chambers of the heart in the absence of mechanical contraction of the atria. The diagnosis is made with an electrocardiogram or by palpating the pulse at the wrist, which is completely arrhythmic. According to the pulse rate, atrial fibrillation can be tachyarrhythmia with a pulse over 100 beats per minute, bradyarrhythmia with a pulse below 40 beats/min and normoarrhythmia with a pulse from 40 to 100 beats/min. For an early diagnosis of this condition, regular palpation of the pulse by the doctor or the patient is recommended, and if an irregular pulse is suspected - an ECG that confirms the diagnosis.
What are the symptoms of atrial fibrillation? Are there any initial signs?
- The symptoms can be very different and are mainly determined by the pulse rate. With a very high heart rate, patients usually feel palpitations, shortness of breath, easy fatigue with light physical exertion. There may be various chest pains, dizziness and unsteady gait. Similar symptoms are also observed with a very low heart rate. With normoarrhythmia, patients may have no symptoms and the disease may be discovered incidentally. Rarely, a very high or very low heart rate occurs with a temporary loss of consciousness, which is a serious symptom and requires clarification and treatment in a hospital setting. In the remaining cases, diagnosis and treatment are usually carried out in outpatient settings.
What provokes the emergence of this condition, what are its causes?
- The most common cause is arterial hypertension, especially untreated or poorly controlled. The second most important predisposing factor is age – in the general population, the incidence of atrial fibrillation averages about 2-3 percent. And for patients over 80 years of age, it is over 10 percent. Other predisposing factors are diabetes mellitus, heart failure, certain valvular diseases, such as rheumatic mitral stenosis, coronary heart disease, obesity, thyroid diseases, inflammatory diseases, such as pneumonia, etc. Exist
three forms of this state:
Eruptive - a sudden episode of palpitations that stops on its own without medical intervention, and usually lasts a few minutes to a few hours.
Persistent - attacks last for varying lengths of time and require medical intervention to terminate.
The third form is the permanent state.
In inflammatory disease or abnormalities in the function of the thyroid gland, it is possible that episodes of paroxysmal palpitations will not recur with the cure of the underlying cause that led to it. With other predisposing factors, such as hypertension, diabetes, and coronary disease, often this arrhythmia recurs over time, with attacks tending to become more frequent and longer lasting. At some point, the patient may remain permanently in permanent atrial fibrillation.
Prof. Trendafilova, what complications can this condition cause? How are these complications treated, as well as atrial fibrillation itself?
- Due to the lack of mechanical contraction of the atrium, there is a high risk of thrombus formation in the left atrium. Parts of them can break off and travel through the blood stream into peripheral arteries of the arm, leg, intestine, or most commonly into the brain, and cause an embolic stroke.
Embolic stroke is caused by blockage of a cerebral artery by a thrombus, with its source most often in the left atrium in patients with atrial fibrillation. The consequences are necrosis (death) of the brain tissue fed by the blocked artery, which is irreversible. Embolic strokes are usually large, with serious disability of patients, with high mortality and a high rate of recurrence - repeated embolic strokes. But I hasten to say right away that they can be prevented with appropriate anticoagulant treatment. Anticoagulants are medications that reduce blood clotting and are taken orally in outpatient settings. Treatment with them lasts a lifetime. Anticoagulant treatment was indicated for all patients in whom the risk of embolic stroke was assessed as intermediate or high according to the appropriate scales established by a physician. The risks of anticoagulant treatment are mainly related to the risk of bleeding, which can occur anywhere in the body, but
most dangerous is in the brain
This is the so-called intracranial hemorrhage. When discussing anticoagulant therapy, it should be known that the risk of embolic stroke is always much higher than the risk of bleeding, therefore anticoagulant therapy is preferable. Anticoagulant treatment has been shown to reduce mortality in patients with atrial fibrillation. Modern anticoagulants reduce the risk of brain bleeding. Their application is easier. They cannot be used in patients with advanced kidney disease and highly elevated creatinine. Aspirin and other antiplatelet drugs reduce the ability of blood platelets to stick together and form thrombi, but they are effective in preventing embolic stroke in atrial fibrillation. But the bleeding risks are similar to anticoagulants. Therefore, these same antiplatelet agents are not recommended for prophylaxis in patients with embolic stroke. Antistenocardine has no antiplatelet properties on its own and should be forgotten.
Another complication of this type of arrhythmia is the development of heart failure, especially with frequent attacks or high atrial fibrillation. In order to avoid heart failure, it is important to control the attacks of atrial fibrillation with antiarrhythmic drugs, but only if such behavior is chosen by the attending physician. Or to maintain a pulse rate around 80-100 beats per minute if the patient is in persistent atrial fibrillation.
Remember: antiarrhythmic drugs carry a serious risk of complications and are only prescribed by a doctor! Self-medication with them can be dangerous and provoke a new type of arrhythmias, some of which can be fatal.