Atrial Fibrillation Guide: Symptoms, Causes, Diagnosis, and Treatment
AFib is a serious condition because it can allow blood to pool and clot in the atria. These clots might then circulate through the blood vessels to the lungs, causing a pulmonary embolism, or to the brain, causing a stroke.
AFib causes symptoms such as heart palpitations and feeling faint. However, not everyone has them. If you do not have symptoms, you may not require treatment. Sometimes, AFib symptoms occur only now and then. In this case, it is a condition called paroxysmal AFib.
This article explains the types, symptoms, causes, and treatment options related to AFib.
According to standard diagnostic guidelines, AFib falls into one or more of these types:
- First-diagnosed AFib: This applies to people when they first get a diagnosis of AFib, regardless of symptoms and number or duration of episodes.
- Asymptomatic AFib: This is also known as silent AFib. It does not cause any symptoms. AFib may be an incidental electrocardiogram (ECG) finding.
- Paroxysmal AFib: This is two or more episodes that end spontaneously within 7 days.
- Persistent AFib: This is two or more episodes that last 7 or more days.
- Long standing persistent AFib: This is AFib that lasts 1 year or longer.
- Permanent AFib: This is when the person and doctor agree that they are no longer pursuing treatment to restore a typical rhythm.
Some people never develop AFib symptoms. Others exhibit the classic signs and symptoms of this common arrhythmia.
People with AFib may experience the following symptoms:
- dizziness or fainting
- heart palpitations (feeling as though your heart is beating too hard or skipping a beat)
- general unexplained weakness
- a rapid heartbeat or an irregular pulse
- shortness of breath, particularly when exercising
- unexplained fatigue
Emergency medical attention
If symptoms of AFib occur with chest pain, seek emergency medical attention. Call 911 for symptoms of stroke, including facial drooping on one side, a loss of feeling in your leg or arm on one side of your body, a severe headache, and difficulty speaking.
Unusual electrical signaling in the heart causes AFib. Sometimes, the heart’s pacemaker cells send impulses out of sequence. This disrupts the regular heartbeat.
Other times, new cells develop in areas of the heart where they do not belong. These atypical cells send signals for the tissue to contract prematurely.
Many conditions can cause this type of rhythm disruption, including:
- chronic and uncontrolled high blood pressure
- coronary artery disease due to atherosclerosis, or the hardening of the arteries
- heart damage from rheumatic fever in childhood or heart surgery
- heart failure
- heart valve disease
- pulmonary embolism
- stress on physiological processes, including older age, chronic lung disease, an overactive thyroid, obesity, and metabolic syndrome
Known mutations in specific genes can cause familial, or hereditary, AFib. However, this accounts for a small percentage of AFib cases. Certain variations in several other genes influence the risk of developing AFib. Of those with AFib, the number who have it due to a gene variation is not known.
Known triggers of an AFib episode include:
- alcohol use
- illegal drug use
- energy drink consumption
- intense exercise
- sleep apnea
- stress and anxiety
One of the main risk factors for AFib is age. This is largely due to accumulated heart damage from such conditions and lifestyle habits as:
- excessive drinking
- coexisting heart disease and uncontrolled high blood pressure
- other chronic conditions, such as diabetes and hyperthyroidism
- sleep apnea
Reducing your risk of atrial fibrillation
You may be able to lower your risk of AFib by:
- controlling your blood sugar
- engaging in a heart-healthy lifestyle
- not smoking, which will reduce your risk of heart disease
- treating existing heart disease, including high blood pressure and other conditions that raise the risk of AFib
If you have AFib, eating a heart-healthy diet is an important part of managing the disease. Your diet should include the following foods:
- beans and legumes
- fruits and vegetables
- lean meats, poultry, and fish
- fat-free or low fat dairy products
- whole grain, high fiber starches
Following a heart-healthy diet also involves limiting saturated fats, trans fats, and extra salt and sugar. With AFib, your doctor may recommend avoiding alcohol as well. It can trigger AFib episodes and lead to other health problems.
Ask your healthcare professional for guidance before making any significant changes to your diet.
To diagnose AFib, your doctor will take a medical history, perform an exam, and order testing. However, you may or may not be aware that you have a problem.
Sometimes, doctors find AFib during a routine exam while listening to your heart. It may also show up on an ECG you have for some other condition or procedure.
Other tests your doctor may order include:
- blood tests to check for thyroid problems or other conditions
- an echocardiogram to look at the heart’s structure and function
- a Holter monitor to record the heart’s activity over 24 hours or an event recorder to document it for up to 30 days
- a stress test to see how the heart responds to physical exertion
Questions your doctor may ask include:
- What symptoms are you experiencing?
- How long have you had these symptoms?
- Are your symptoms constant, or do they come and go?
- What, if anything, seems to make your symptoms better or worse?
- What other medical conditions do you have?
- What medications do you take?
Not everyone requires treatment for AFib. Your doctor usually will treat the condition if you have severe or persistent symptoms or another underlying heart disease. The treatment goals include slowing the heart rate, reducing the risk of blood clots, and restoring and maintaining a regular heart rhythm.
AFib treatment may include:
- medications, including antiarrhythmic drugs, beta-blockers, calcium channel blockers, and anticoagulants or antiplatelet drugs
- electrical cardioversion, which is a noninvasive treatment option that delivers electrical impulses to the heart to reset the natural rhythm
- cardiac ablation with a catheter, which is a minimally invasive procedure that selectively destroys heart cells that may be producing errant electrical signals
- catheter-guided closure of the left atrial appendage, which is a pouch connected to the left atrium to prevent potential blood clots from entering the bloodstream
- heart valve surgery in cases where a faulty valve is causing AFib
- Maze surgery, which can restore a regular heart rhythm by making strategic incisions in the atria to disrupt the transmission of faulty signals
- pacemaker implantation in cases where the surgeon removes the heart’s natural pacemaker node to correct the arrhythmia
Complications of AFib can range from inconvenient to serious and life threatening.
Potential AFib complications include:
- a blood clot that travels to the brain, causing a stroke, or to the lungs, causing a pulmonary embolism
- chronic fatigue
- heart failure
- persistent shortness of breath
You can help reduce your risk of serious complications by following your treatment plan.
If you need treatment for AFib or confirmation of an AFib diagnosis, contact a cardiac electrophysiologist. This doctor is a cardiologist who specializes in arrhythmias. An experienced specialist will have the most up-to-date knowledge and expertise regarding AFib treatments.
People with AFib do not usually die from the fast and irregular heart rhythm itself. However, they have a fivefold higher risk of stroke compared with people without AFib. This is because, during AFib, blood does not completely empty into the left ventricle. Blood left behind in the atria can pool and form a clot. If part of the clot breaks away, it can move into the circulation and lodge in a blood vessel in the brain, causing a stroke.
As stroke is one of the leading causes of death and disability in the United States, it is especially important for people with AFib and their loved ones to know the symptoms of a stroke.
Some people with AFib can die from a fast and irregular heart rhythm. This is called AFib with a rapid ventricular rate. It can quickly lead to low blood pressure and acute heart failure, which can lead to cardiogenic shock. This can be fatal without treatment.
What are the symptoms of a stroke?
Symptoms of a stroke include:
These symptoms usually happen suddenly and are asymmetric, meaning that they affect only one side of the body.
The following common questions have been answered by Dr. Megan Soliman, M.D.
What is the best way to treat atrial fibrillation?
The best way to treat AFib depends on an individual’s symptoms and risk factors, including other medical conditions.
For example, a person under the age of 65 years with no other medical conditions and who is asymptomatic may need no treatment.
On the other hand, someone who is 75 years old with a history of high blood pressure and diabetes and who is symptomatic may benefit from blood thinners as well as medications to help control their heart rhythm or rate.
People who remain symptomatic despite maximum medication therapy may then benefit from something procedural, such as ablation.
What is the most common cause of atrial fibrillation?
One of the most common risk factors for AFib is increasing age. High blood pressure goes directly along with that, as the risk of high blood pressure increases with age as well.
Can atrial fibrillation damage your heart?
Apart from potentially forming blood clots in the heart due to ineffective pumping with AFib, congestive heart failure is a common complication. This can happen quickly if someone has AFib with a very fast rate, and it can also happen over time due to the progressive weakening of the heart muscle.
What is the best sleep position for atrial fibrillation?
Interestingly, recent studies have suggested that sleeping in a left lateral position is a trigger for people with AFib. Obstructive sleep apnea is also a known risk factor for AFib, so if someone is having daytime sleepiness, difficulty sleeping, or snoring, they should consider undergoing a sleep study.
Is it OK to drink coffee with atrial fibrillation?
Although excessive amounts of caffeine have been known to trigger AFib episodes, moderate coffee consumption of about one to three cups per day is generally considered safe.
AFib results from a problem with the heart’s electrical system. Doctors can diagnose AFib based on a person’s medical history, risk factors, and heart test results. This includes tests such as an ECG, a Holter monitor, and other diagnostic and imaging tests.
With early diagnosis, AFib can often be curable. AFib treatment includes medications, cardioversion, and ablation. An ablation is a procedure to destroy clusters of cells in the heart tissue that are causing the erratic heartbeats.
With successful treatment and monitoring, most people can greatly reduce their risk of blood clots and other serious complications associated with AFib.