What is Atrial Fibrillation?

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2 What is Atrial Fibrillation? Atrial fibrillation, or AF, is the name for a type of irregular heartbeat. Your heart is located in your chest and it is a muscle about the size of a clenched fist. Its function is to pump blood around the body. The heart has its own electrical system and this is normally under the control of a pacemaker. The heart s natural pacemaker, or sinus node, creates electrical signals to make the heart beat regularly. Normally the sinus node controls the rate of your heart beat and it can change your heart rate depending on what your body needs at a given time. Heart Rate is the number of times your heart beats per minute. For most people this is between 60 and 100 times a minute. Heart Rhythm is how regular your heart beats. Normal heart rhythm is called sinus rhythm. If you have been diagnosed with a condition called Atrial Fibrillation (AF) the normal signal from the sinus node is not being allowed to work properly and therefore your heart will not beat in a regular fashion.

3 What are the symptoms of AF? Some people with atrial fibrillation do not have any symptoms and their AF is only discovered during a medical examination. Not everyone has the same symptoms. These are the most common symptoms: Palpitations (or awareness of your heartbeat) which may be rapid Tiredness Shortness of breath Dizziness, faintness or feeling lightheaded Chest discomfort Difficulty exercising 1

4 What causes Atrial Fibrillation? How is AF diagnosed? Atrial fibrillation may be detected very simply by your doctor or nurse feeling the pulse in your wrist or listening to your heart with a stethoscope. It is confirmed by a test called an electrocardiogram (ECG). An ECG is a quick and painless test, when special pads (electrodes) are placed on your arms, legs and across your chest to record the heart rhythm. It usually takes just a few minutes and it can be done in your GP practice or in hospital. The causes of atrial fibrillation are not known in many patients. We know it is more common in older people. It is also more likely to occur if you have other heart conditions, such as: High blood pressure Heart disease Heart surgery Diabetes Thyroid gland disorders Pneumonia Chest infections Pulmonary embolism (blood clots in the lungs) Excessive alcohol use or drug abuse It may be harder to detect atrial fibrillation if you do not have it all the time - where the irregular heart rhythm comes and goes by itself. If you have this type of AF it may be necessary to have your ECG tracing recorded for 24 hours or longer. This can be done by using a holter monitor which is done using a small device with sticky pads (electrodes) placed on your chest. The monitor is easy to carry and easily hidden under your clothes. You do not need to stay in hospital for this test. There is often no known cause of AF. 2

5 Are there different types of Atrial Fibrillation? Atrial fibrillation is often intermittent, meaning that it can come and go without warning. There may also be long spells between episodes. In fact, some people in this early stage of AF may not even be aware they have it. Atrial Fibrillation falls into three categories, which also help to describe the progression of the condition. 1 Paroxysmal AF Episodes come and go on their own and last no longer than 7 days. 2 Persistent AF Episodes last longer than 7 days and do not go away on their own. Medical treatment may be considered to restore normal sinus rhythm. 3 Longstanding Persistent AF Continuous AF which has occurred for more than one year. 3

6 Why is Atrial Fibrillation important? Atrial fibrillation itself does not pose a direct or immediate risk of death. Many people live with this condition for decades. However, atrial fibrillation can lead to serious complications. These possible complications include: Stroke Heart failure Having to go to hospital The most common and serious complication of atrial fibrillation is stroke. The risk of having a stroke is 5 times higher in people with AF than in those without it. AF related strokes are more severe. You can reduce your risk of atrial fibrillation by looking after your overall general health, making sure you have a healthy diet, take regular exercise and take any medications prescribed by your doctor. 4

7 What is a stroke? Heart Failure A stroke occurs when the blood flow to part of the brain is blocked. In most cases a stroke is caused by a blood clot. When you have AF, the upper chambers of your heart pump irregularly. Some blood pools in these chambers and forms a small blood clot. This blood clot can travel out of your heart to your brain, causing a blockage in the blood supply leading to a stroke. To reduce the chance of having a stroke, it is important to follow the advice of your doctor or healthcare professional and to take your medication as prescribed. Uncontrolled AF can prevent the heart from pumping as well as it should. This can lead to long term complications like heart failure and other heart conditions. Heart failure is a term to describe the heart s failure to pump as efficiently as it should. 5

8 Treating AF Atrial fibrillation is treated in different ways. You may be prescribed medication to thin your blood, slow down your heart rate or regulate the rhythm of your heart. Some people also require hospital procedures for their AF. What medicines might I be given for Atrial Fibrillation? Blood-thinning drugs used to reduce the risk of stroke (anticoagulants). Drugs which slow down the heart rate, particularly if you have symptoms such as palpitations (beta blockers). Drugs which can help to restore the heart s normal rhythm (sinus rhythm) and to prevent the return of atrial fibrillation (anti-arrhythmic drugs). 6

9 The essential facts you should know Will I need to take medicines for the rest of my life? Atrial fibrillation increases the risk of stroke and you will usually stay on your bloodthinning medication for life. There may be some circumstances when your bloodthinning medication is stopped, but if it is necessary to stop this medication then your doctor will explain the reasons for this to you. If you have treatment which restores a normal heart rhythm (for example, cardioversion or ablation) you may still need to continue taking a blood-thinning medicine. This is important because atrial fibrillation can return without you being aware and this can increase your risk of stroke. You may also have other risk factors (e.g. high blood pressure, diabetes, or have suffered a previous stroke) all of which place you at higher risk of stroke and in these cases you doctor will usually recommend that you continue taking a blood-thinning medicine for the rest of your life. In some cases, if your risk of stroke is very low - you have atrial fibrillation and no other risk factors for stroke, and if the episodes of atrial fibrillation have disappeared completely, then it may be possible to stop taking medication. Your doctor will advise as decisions on medication will be made based on your own situation. What medications can be used to thin my blood? Blood-thinning drugs known as anticoagulants are taken to reduce the chance of blood clotting and reduce the risk of a stroke occurring. Your doctor will provide you with a booklet in relation to the specific bloodthinning medication you may be taking. 7

10 What medicines can be used to reduce my episodes of AF? The drugs used to reduce episodes of atrial fibrillation are called antiarrhythmics, which change the electrical activity of the heart. Sometimes your doctor may have to try several antiarrhythmics before finding the one that suits you best. What about hospital procedures? Your doctor may suggest that you have a procedure called a cardioversion. This aims to restore your heart rhythm back to normal sinus rhythm and involves delivering a controlled electric shock to your heart. The electrical impulse is strong enough to stop the heart s electric signals and to let the heart s natural pacemaker, the sinus node, regain control over the rate of your heart. Electrical cardioversion is done in hospital using a machine called a defibrillator. A small shock is delivered through two large stickers (electrodes) attached to the chest. It is a very safe day procedure done under sedation so you do not feel any pain or discomfort. You will be admitted in the morning and discharged by lunchtime the same day. Sometimes, even though regular rhythm is restored, the atrial fibrillation may return so continued follow-up with or without medication is usually required. Will I be able to live a normal lifestyle? Your doctor will decide on the most appropriate anti-arrhythmic drug for you based on other medical conditions you have. There may be things to be aware of with certain medications that you may need to take and your doctor will discuss these with you. A healthy lifestyle and a balanced diet are especially important for people with atrial fibrillation. Limit your 8

11 intake of alcohol and other stimulants such as strong tea or coffee. Do I have to stop drinking alcohol? What should I eat? You should eat a healthy and balanced diet and if you are overweight, try to lose weight. It is strongly recommended that you don t drink large amounts of alcohol. Excessive intake of alcohol can increase the risk of bleeding among patients who take blood-thinning medication. Do I have to stop exercising? Physical activity is important for your overall health. It improves sleep and mood and is important for weight control. Before starting any exercise programme you should consult with your doctor or healthcare professional. Do I have to stop smoking? Your doctor will recommend that you stop smoking as it is important for your overall health. If you have AF more damage occurs because smoking makes the heart beat faster, and reduces the oxygen in the blood. If you have high blood pressure it is advisable to eat foods low in salt and you should not add salt to your food when cooking or at the table. Should I stop drinking coffee, tea and other caffeinated drinks? Drinking too much caffeine can raise your blood pressure and increase the heart rate, which might trigger atrial fibrillation. It is advisable not to exceed 2-3 cups of caffeinated drinks per day. Further information 9

12 Diary Use these pages to: Track your symptoms Identify triggers and ways to avoid them Date 10

13 Questions for your Doctor 11

14 Your current medications Medication Name What it does Dosage 12

15 When do I need to take it? MORNING MIDDAY EVENING NIGHT Additional Information

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