Atrial Fibrillation: Types ,Symptoms, Causes, Risks, Complications, Diagnosis, Treatment, Prevention and Prognosis

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Illustration of normal ECG and Atrial fibrillationof.

1Overview

The Heart is equipped with a conduction system that orchestrates the muscles of the heart to contract. There are four components of the electrical system of the heart: Atrioventricular Node (AV node), Sinus Node (SA node), and the Bundle of His and Purkinje fibers.

The Sinus node (SA node) is the main conductor of electrical impulses that are delivered throughout the heart muscles. The sinus node is found in the atrium at the center of the heart.  The electrical impulses then will travel to the Atrioventricular node (AV node).
The AV node then will receive the signal from the sinus node and regulates it to prevent early contraction of the ventricles. The electrical signals go down passed to the Bundle of his goes through the branches and eventually to the Purkinje Fibres.

An interruption in the conduction of the heart may cause problems like atrial fibrillation wherein the Atrioventricular node cannot regulate the impulses sent by the sinus node.

The normal function of the nodes produces contractions of the heart muscles. During an auscultation of the heart, the “lub-dub” sound which you hear using the stethoscope, indicates that the atria and the ventricles are in sync with each other. In atrial fibrillation, the atria will contract faster causing the blood not to be properly circulated in the heart. People with atrial fibrillation have a greater risk of having a stroke due to the clotting of the blood.

2Atrial Fibrillation is classified into three types:

Permanent atrial fibrillation

As the name implies is the condition where the heart is in an irreversible state. No medications or other treatments will be able to correct the conduction system of the heart.

Paroxysmal atrial fibrillation

The heart may have episodes of fibrillation then goes back to its normal rhythm. The pulses may vary in the rate during an assessment.

persistent atrial fibrillation

intervention is needed to correct the rhythm of the heart. Medications and cardioversion may also be done to bring the rate to normal.

3Symptoms

People who have atrial fibrillation may not have symptoms that can be seen.
Atrial fibrillation may have no symptoms, like older people and can only be diagnosed through series of examinations. Other reports have said that some people may have experienced fatigue, dizziness, light-headedness, Shortness of breath, palpitations and even chest pains.

4Causes

There are many causes of atrial fibrillation from heart diseases, lifestyle to health issues.

Heart Diseases

  • Valvular Heart Disease – The defects in the structure of the heart may cause damage and problems to blood flow of the heart.
  • Coronary Artery Disease – The formation of plaques along the artery walls which causes the constriction and even blocking of the vessels, impeding the blood flow.
  • Congenital diseases – Acquired right after birth. The non-closure of the septum can greatly affect the blood flow in the baby. Symptoms like a cyanotic baby and fast breathing can be seen.
  • Heart attack – Patients having atrial fibrillation has an increased risk of having heart attacks due to the pre-existing condition of the heart.
  • Sinus syndrome – A malfunction in the electrical system of the heart can disrupt the conduction and contractions of the heart muscles.

Lifestyle

  • Caffeine – Caffeine is a substance that stimulates the heart rate to increase. People who drink coffee beyond the allowable amount may increase the risk of having atrial fibrillation.
  • Medications – Certain medications can cause atrial fibrillation like cardiac stimulants.
  • Smoking and alcoholism can also do damage the heart in the long run.
  • Obesity – Being obese may increase the risk of various heart problems.

Diseases

  • Smoking and alcoholism – Smoking and alcoholism can also damage the heart in the long run.
  • Lung diseases – pneumonia and Chronic Obstructive Pulmonary Disease (COPD) may increase the risk of atrial fibrillation.
  • Thyroid gland problems – Thyroid hormones act on the heart. Any disruptions in the production of these hormones can affect the heart greatly, causing heart problems.

5Risk Factors

The elderly clients, 60 years old and above are at risk of developing atrial fibrillation due to weakened heart muscles and the like. The same as the causes of having atrial fibrillations, it can be a risk too. Normal people who don’t have the disease yet may eventually acquire it through:

6Complications

If atrial fibrillation is left untreated, serious complications may arise. Formation of blood clots is more likely to develop due to the improper circulation of the blood. When this happens there is a greater risk of having a stroke. A stroke is caused by a blockage of the vessels that deliver the blood all throughout the body. Usually, it happens in the brain which causes hypoxemia and is a life threatening event that should be addressed immediately.

Another complication is heart failure. Having to exert more effort in pumping the blood out, the heart compensates and eventually gave in causing the heart to fail.

7Diagnosis

The doctor will do a thorough physical exam and obtain a medical history. A blood test will be done to determine the levels of the thyroid hormones, white blood cell count to know if there is an infection happening in the body.  Routine chest x-ray, to see the condition and structure of heart and lungs. Viewing the heart and lungs may help identify if there are any deviances in the structure.

An electrocardiogram (ECG) determines the rate and rhythm of the heartbeat through leads that are attached to the chest anatomically. Seeing the pattern of the beat in the ECG sheet can help us know if it is atrial fibrillation, Premature Ventricular Contractions (PVCs), Heart Blocks or even ventricular fibrillation.

An echocardiogram is a machine that uses sounds to create the exact image of the heart. These instruments are placed on the chest and introduce sounds and when the sound bounces back the machine interprets it into a picture. This can determine the structure and function of the heart and other abnormalities like the formation of blood clots inside the heart.

Just like the electrocardiogram, the Holter monitor records the heart rate and patterns for a day (24 hours). This can help the doctor gather more accurate data that can be missed in the electrocardiogram. It is portable so the patient can carry it with him.

8Treatment

After determining the cause of the atrial fibrillation, the doctor can now decide what treatment will be better for you. Some patients may have underlying causes like thyroid problems, treating this through medications can address the atrial fibrillation and its symptoms.

Lifestyle causes may be changed like diet restrictions and increase in activities to prevent predisposing factors. The treatments can also be dependent on how long the condition is present.

Preventing blood clots is one of the treatments, medications like blood thinners or anticoagulants are given to patients who have atrial fibrillations.  The anticoagulants have side effects that should be noted if prescribed by the physician kindly follow the instructions to avoid adverse effects of the drugs. Medications like Beta-blockers and calcium channel blockers aids in the slowing down the heart rate thus helps prevent the occurrence of atrial fibrillation. Anti-arrhythmic drugs also help reset the heart rate, side effects should be noted and reported to the doctor.

Surgical procedures may also be an option to treat atrial fibrillation Catheter Ablation is usually done by inserting a tube into the heart and destroying the muscle tissue that is affected either by using hot or cold shocks. After disabling the tissue, the irregular conduction in the system will be regularized and by inserting a Pacemaker in the heart helps it to regulate and correct the rhythm of the heart.

If all medications and treatments are not working, the doctor may suggest heart surgery. Maze surgery is done if the patient is not responding to all kinds of treatment. The surgeon will make an incision in the heart, scarring the tissue and disrupting the electrical impulses that cause the abnormality in the conduction system.

9Prevention

Normal people not having any pre-existing heart condition can improve and have a healthy lifestyle, this is the best way to prevent having an atrial fibrillation.

  • Diet changes would be required like eating foods less in salt, fat, and cholesterol.
    This can help reduce the risk of having heart diseases.
  • Do exercises that involve cardio workouts to improve the heart status.
  • Avoid smoking and drinking alcohol
  • Do not take medications that are not prescribed by the doctor to prevent adverse and unwanted effects in the body.

People with heart problems or conditions must also do the preventive measures as mentioned above and to take extra precautions and measures to maintain or to prevent further progression of the disease.

  • Stick with the diet plan as prescribe by the dietician
  • For patients who have Diabetes: always check and maintain your blood sugar to avoid complications.
  • Medications must be followed religiously and report any signs and symptoms to your physician.

10Prognosis

Having atrial fibrillation possess a great risk of having complications but by having a regular check-up and adhering to the treatment plan may improve the prognosis of the patient.  It is true that having this condition may affect the quality of life and may shorten the life expectancy of the person but new treatments are already in use to treat and manage the conditions that come with it.