Ask the Doctors: Atrial fibrillation diagnosis requires cardiologist’s care
Dear Doctor: Our mom is 66 years old and has always been healthy. She was diagnosed with atrial fibrillation during her last physical. She says she feels fine, so she hasn't followed up with her doctor. What can happen if she doesn't get treatment?
Dear Reader: Atrial fibrillation is a common heart rhythm disorder, or arrhythmia, that affects anywhere from 2.5 million to 6 million people living in the United States. Also referred to as AFib or AF, the condition causes a rapid and irregular heartbeat. People living with AFib have an increased risk of stroke, heart failure and other heart-related complications. The good news is that there are several effective treatment avenues for the condition. Without treatment, however, the symptoms of AFib often get worse.
The condition gets its name from an electrical malfunction in the upper chambers of the heart, known as atria, which pump blood into the ventricles, the two lower chambers of the heart. It occurs due to a glitch in the sinus node, a cluster of specialized cells in the upper wall of the right atrium, which act as the heart's natural pacemaker. Instead of producing a steady, rhythmic contraction, the atria quiver, or fibrillate. The result is a disorganized heartbeat, rapid and irregular, which interferes with optimal blood flow. It often causes blood to pool in the left atrium, which can lead to the formation of blood clots. If a blood clot breaks free, it can circulate and block blood flow to other parts of the body. A blood clot that travels to the brain can cause a stroke.
Many people with AFib — and it sounds as though your mother may be one of them — don't experience any noticeable symptoms. Those who do will feel a jittery, racing heartbeat; the sensation of a skipped heartbeat followed by a "thump" within the chest; exhaustion; shortness of breath; dizziness; chest pain or pressure; or unusual fatigue during exertion. The condition runs the gamut from mild to severe. Occasional episodes, known as paroxysmal AFib, last from a few seconds to a few hours, and the heart recovers on its own. AFib that requires medication or an electric shock to return to normal rhythm is labeled as persistent. Permanent AFib is when normal heart rhythm cannot be restored.
Treatment depends on which specific type of AFib a person has, as well as on any additional medical issues that may be present. In all types of AFib, the dual goals are to restore normal heart rate and to prevent blood clots. Medications such as digoxin, beta blockers and calcium channel blockers may be used to restore heart rate. Blood thinners, including Warfarin and newer anticoagulants, are often prescribed to prevent stroke. If medications don't work, procedures to inactivate the sinus node cells causing the arrhythmia may be used. In some cases, a pacemaker is the best option.
Even though your mother can't feel the symptoms of her AFib, the condition is dangerous when it goes untreated. We strongly urge her to see a cardiologist and begin a potentially lifesaving therapy.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.