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Abnormal heart rhythms up chance of stroke
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Dr. Thomas Salvucci talks to patient Mary Curtis during an office visit. |
Atrial fibrillation — the most common abnormal rhythm of the heart — is one of the most common reasons for hospitalization. It also increases a patient's chance for a stroke. A half million new cases are diagnosed yearly in the United States. Treatment is simple, but not treating the condition can be a different story.
"The most common symptom of atrial fibrillation is palpitations, an uncomfortable awareness of a rapid and irregular heartbeat," said Dr. Thomas Salvucci, a cardiologist with Skyline Cardiovascular Institute. "Other symptoms include dizziness, fatigue, weakness, shortness of breath and chest pain.
Many patients with atrial fibrillation have no symptoms and are unaware of their abnormal heart rhythm. Oftentimes it is discovered when a patient is visiting the doctor for a checkup or when he or she is sick. It is easy to diagnose because the doctor can hear the rapid and irregular heartbeat using a stethoscope or by taking a patient's pulse, Dr. Salvucci explained.
Risk factors for developing atrial fibrillation include age, coronary heart disease, high blood pressure, diabetes and history of heart disease.
"Atrial fibrillation is common in patients over the age of 70," Dr. Salvucci said. "With the aging population in our society, we are seeing more and more patients with the condition. All patients with atrial fibrillation require further investigation as to the cause of the condition, but seeing it in a patient under 60 causes us to look more closely for more serious cardiac conditions to rule out there is not more going on."
In a heart that is beating normally, the rate of ventricular contraction (lower chambers) is the same as the rate of atrial contraction (upper chambers). In atrial fibrillation, the rate of contraction in the lower chambers is less than the rate in the upper chambers.
Dr. Salvucci says it is rarely a life-threatening diagnosis; many patients can do reasonably well with proper treatment.
"There are two initial goals in treating atrial fibrillation, to slow the heart rate down and to thin the blood," he said. "As the condition is a major cause of stroke, a common treatment is blood thinners, such as Coumadin, but there is a sub-group that can be treated with aspirin. We determine the course of treatment based on the presence or absence of other conditions or factors, such as congestive heart failure, hypertension, age, diabetes and prior stroke.
Converting atrial fibrillation to a normal rhythm can usually be accomplished with other medications (chemical/medical cardioversion) or by electrical shock (electrical cardioversion).
Successful treatment can alleviate symptoms, improve exercise tolerance and your quality of life and lower the risk of strokes. Medical cardioversion is usually tried first. Electrical cardioversion requires the administration of an electrical shock to the chest, which stops the abnormal electrical activity of the heart for a brief moment and allows the normal heart rhythm to take over.
Your cardiologist also may consider an alternate treatment called ablation, which is a catheter-based procedure performed by a heart specialist called an electrophysiologist.
"A diagnosis of atrial fibrillation does not mean that a patient will have to have a pacemaker," said Dr. Salvucci. "We normally do not use a pacemaker to treat atrial fibrillation, unless there is another underlying factor such as Tachy-Brady syndrome, or if the use of typical medications causes too much slowing of the heart."
Once atrial fibrillation is treated, patients can easily return to their normal activities, said Dr. Salvucci. "Treated, the condition has no great impact on a patient's longevity, and it reduces his or her chance of having a stroke. Ignoring the condition increases the chance of stroke and heart damage. The longer it goes untreated, the greater the chance it cannot be corrected."