Atrial Fibrillation And Stroke

Atrial fibrillation occurs when the normal, regular, synchronous action of the upper chambers of the heart becomes chaotic, rapid, and inefficient.

Some who go into atrial fibrillation know it right away because they feel bad-they feel what we doctors term palpitations: their heart beating rapidly or irregularly (fluttering). They may have other symptoms associated with this such as dizziness, chest pain or shortness of breath. Many, however, go into atrial fibrillation and are not aware of it.

The first symptom they feel may be a stroke due to a clot developing in the upper chambers of the heart dislodging and going down an artery to the brain,

Patients may wonder “Why Did I Go Into Atrial Fibrillation”

And they may also be interested in “Why I Favor The Restoration and Maintenance of Sinus Rhythm For Most Patients With Atrial Fibrillation.”

Given the increased stroke risk, if you have afib you should definitely read my post on “Which Patients Should Take Blood Thinners.” which will  give you an idea of which blood thinner (anticoagulant) to take.

Posts on Diagnosing Atrial fibrillation

Take your pulse and prevent a stroke

TIAs and silent atrial fibrillation. Sometimes strokes present in unusual ways, like the inability to differentiated a spade from a diamond when playing bridge and afib is often the cause.

Estimating Stroke Risk in Patients With Atrial Fibrillation You can estimate your stroke risk using an app that utilizes the CHAD2DS2-VASc score. I prefer to call the Lip score.

Posts About Using Personal Devices To Diagnose Atrial Fibrillation

Two That Work Well

  1. AliveCor’s Kardia

Using a Smart Phone Device and App To Monitor Your Pulse for Atrial Fibrillation (AliveCor)

AliveCor Is Now Kardia and It Works Well At Identifying Atrial Fibrillation At Home And In Office

AliveCor Successes and Failures.

Sustained Atrial Fibrillation or Not: The Vagaries and Inaccuracies of AliveCor/Kardia and Computer Interpretation of ECG Rhythm

    2. Apple Watch 4 and higher

           Apple Watch posts (here, here and here)

__________

Devices/Apps to avoid for AF detection

Do NOT Rely on AF Detect Smartphone App To Diagnose Atrial fibrillation

Sonohealth’s EKGraph 

Emay

Posts About Treatment Of Atrial Fibrillation

        Lifestyle Changes

How Obesity Causes Atrial Fibrillation in Fat Sheep and how Losing Weight can reduce the recurrence of atrial fibrillation.

Eight Lifestyle Changes to Prevent Atrial Fibrillation

Drug Therapy: Rate Control and Anticoagulation

Foxglove Equipoise. When William Withering began treating patients suffering from dropsy in 1775 with various preparations of the foxglove plant he wasn’t sure if he would help or hurt them. After 240 years of treatment, we are still unsure if the drug obtained from foxglove is useful.

Should Digoxin Still Be Used in Atrial Fibrillation? Recent studies suggest that we should not.

Why Does the TV Tell Me Xarelto Is A BAD Drug? Anticoagulant drugs that prevent the bad clots that cause stroke also increase bleeding risk. A bleeding complication is not a valid reason to sue the manufacturer.  The lawsuit are strictly a money-making tactic for sleazy lawyers.

Drug Therapy: Antiarrhythmic Drugs for Maintenance of Sinus Rhythm

If lifestyle changes alone can’t control atrial fibrillation, I am an advocate of enlightened use of medications (antiarrhythmic medications or AADs) that can safely restore and maintain the normal sinus rhythm long term.

The most recent study supporting drug therapy for suppressing atrial fibrillation, EAST-NET AF

My three-part series on “enlightened medical management of AF”:

Part I: Amiodarone. Kardia and Cardioversions

Part II: The Pill in Pocket Approach

Part III: Flecainide for Chronic AF Suppression

 

Cardioversion and Ablation

We can shock (cardiovert) the heart back to normal rhythm with little risk and very high success rate when performed by experienced and enlightened cardiologists. Keeping the rhythm normal after successful cardioversion is a bigger challenge (see above) and when medications and lifestyle changes fail an invasive procedure (ablation) is an option for some patients. Ablation should not be considered a cure for AF as recurrence is common and successfull ablation has not been shown to lower stroke risk thus anticoagulants are still recommended lifelong after the procedure.

Cardioversion: How Many Times Can You Shock The Heart?

Ablation: Cautionary Words From Dr. John Mandrola and The Wisdom of a Team Approach

Catheter Ablation of Atrial Fibrillation: Will it Reduce Your Risk of Death, Serious Bleeding or Stroke? 

Ablation For Atrial Fibrillation: One Patient’s Experience

 

Miscellaneous

What Happens If You Go Into Atrial Fibrillation On A Cruise?

Apple watch versus Kardia to monitor atrial fibrillation from home: A case study

 

Videos

Take a look at this video to get a good understanding of what happens in atrial fibrillation:.

 

The first symptom of afib may be a stroke due to a clot developing in the upper chambers of the heart dislodging and going down an artery to the brain, a process beautifully (seriously, this is really wonderful and the narrator has a great British accent) animated in this video:

 

This page was updated last 1/10/2020

Antifibrillatorily Yours,

-ACP

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8 thoughts on “Atrial Fibrillation And Stroke”

  1. I’m a very athletic 64 yr old woman. with an intermittent Afib that began in 2012 at approximately the same time as my GERD. Never had either before.Been healthy weight and very active all my life until I was in my 40’s, gained 50 lbs of meno weight. Got it off in 10 months in 2015 and kept it off easily for 2 plus years. Last summer started to regain despite no lifestyle changes. am now 12-15 lbs heavier but still jogging 2 miles a day, 5 days a week, plus strenuous hiking 1-2 days a week. Had extensive thyroid work done, all shows ‘normal’ despite some ‘low normal’ readings. Doctors have been less than helpful or caring. Primary didn’t put a stethascope on my for 3 years..
    My Afib was ‘timed’ for years, 7-15 days apart, lasted about 18-24 hours if I did nothing. I found quite accidentally that jogging would restore rhythm. Also I suspect it’s a vagal Afib, and my resting heart rate does not accelerate much at all, going from a normal of 60 to 75-80. I do have significant discomfort, loss of stamina (although I can still jog, just doesn’t feel good), some indigestion, and lately, pressure at the base of my throat, and sometimes chest pressure, upper right quadrant. Also a bit tight with breathing OUT.
    March 2019 timing changed, more frequent, and two episodes of every two days. Went to cardio with my concerns. She found a heart murmur and suggested a portable ECG, which I bought. Put me on 25 mg of metoprolol. Also scheduled me for an echo and non chem stress test for June. Portable meter is the Emay. I sent the first two, a normal and an Arib to them in early May. Can’t seem to get anyone to respond from their clinic. The medication made my heart rate (not in Afib) to drop below 55 bpm, I was alarmed and asked them about it. No response. I was then told after two emails to the nurse that the doctor would be back in touch and that was 10 days ago.
    I stopped the medication on my own due to the dropped heart rate. And it didn’t seem to do anything to extend my episodes. After stopping it, I went 9 days without an episode. Then 8 days. But now have had two in three days, this last with much discomfort in my chest. Some readings are showing a range in heart rate of 55-80 per 30 sec test.
    Frankly I’m getting frightened and don’t understand the lack of interest from the cardiologist. Any thoughts that could direct me to getting this handled? Also have rotten insurance that requires I pay for everything up to $6500, could that be the reason I am basically being ignored? I need some help.

    Reply
  2. Hi, love your articles and calming advice. Have you checked out the KardiaMobile 6L yet?

    Reply
  3. I live in an area where cardiologists are few and far between. The two I’ve seen do not take me seriously when I describe my heart issues and don’t do the halter monitoring. So I bought a Kardia finger pad and app and I have readings that come up possible atrial fibrillation. I showed them to the docs and neither of them gave them any credence because they couldn’t replicate it on their machines & they don’t know anything about Kardia. I am concerned. I tried to attach the most recent here but it will not take the document. Should I be worried?

    Reply
  4. anti-coagulants reduce risk of stroke…okay…but how much? What percentage and what proof? I can’t find hard evidence try as I have.

    Reply
  5. What about paroxysmal atrial fib, normal heart, liw cholesterol of 150, low bp 100/68, no diabetes. Not obese. Women of 66 with L-thyroxine treated hypothyroidism. Walks two miles a day. Normal echocardiogram
    Recent dx of ductal carcinoma insitu and lumpectomy.
    She is in Eliquis.
    What next? Is there a non drug way? The EP cardiologist wants to add Flecainide.

    Reply
    • Teepu,
      I hope soon to publish my post on maintaining normal rhythm for afibbers. It is a complicated topic.
      A common question is “is there anything I can do?”
      Recent evidence suggests that if you are overweight, losing 10% of body weight helps lower recurrence of AF.
      If drinking more than 1 alcoholic beverage today you should cut down. Make sure your thyroid levels are normal, your potassium is >4 and your magnesium >1.9
      Be aware of personal triggers: most of the time afib begins randomly but for some a specific good, or caffeinated beverage or a very stressful experience will set off AF.
      If episodes begin during sleep, consider testing for sleep apnea.
      If considering drug therapy, flecainide is a good choice for you as your heart is structurally normal. Well tolerated, no long term side effects and reasonably effective. You should get some assessment for coronary artery disease prior to starting.

      Reply

Please leave your comments. The skeptical cardiologist loves feedback. He reads all and replies to all that warrant a reply.

Anthony C. Pearson M.D., F.A.C.C. is a cardiologist, musician, writer and a regular columnist at MedPage Today

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