Atrial Fibrillation: Getting the Rhythm Right

A steady, rhythmic heartbeat in you or someone you love may be the most reassuring sound on earth. Yet some people experience a heart rhythm that is occasionally too fast, too slow, or irregular—for no apparent reason. Any of these symptoms may indicate atrial fibrillation (or AFib), the most common abnormal heart rhythm in adults.

This blog focuses on this condition, which—because of its widespread prevalence—is one we treat daily at the MedStar Heart & Vascular Institute. While the majority of Afib patients are older (70 years and up), we also see patients in their 40s, 50s, and 60s with this arrhythmia. Indeed, the primary driver of AFib is advancing age, and by the time we’re 80, about 15–20% of us will have this rhythm disorder.

What Causes Heart Palpitations?

The heart is an exquisite muscle that collects oxygen-depleted blood from the body, pumps it to the lungs for a refill, then propels this freshly aerated, life-giving blood back to our organs and tissues. Orderly flow of electricity though the heart muscle generates this squeezing sequence, a perfect choreography of electrical flow and mechanical contraction that emerges in the earliest weeks of life within the womb and continues until our last breath.

AFib is an electrical “hijacking” of this process, rendering the organized and regular flow of electricity through the heart completely chaotic. While the pulse in these patients may be rapid, slow, or even within the normal range, it becomes irregular. The result is a heartbeat that resembles an engine that suddenly starts knocking because its pistons are firing out of sequence. In some people, this inefficient heart pumping may be barely noticeable, while in others, it can be debilitating.

Symptoms and Timing

Severe presentations of Afib can make patients feel very tired, even with minimal activity. Other symptoms may include lightheadedness, dizziness, shortness of breath, and a sensation of heart racing or “flip-flopping.” In milder cases, any of these symptoms may be present but not as severe. Patients may even just feel a generalized malaise. And in some lucky patients, there may not be any symptoms at all. They may have atrial fibrillation that progresses to being permanent without ever noticing anything wrong.

For some individuals, symptoms during the day are more common—for instance, during physical exertion. In others, symptoms emerge at night, when the body is less active and the heart rate is slower.

Two Types of Afib

The combination of aging and an individual’s genetics underlies the most common type, known as Primary Afib, because no discrete, reversible cause for the rhythm disturbance can be identified. As noted, about 15–20% of people will experience Primary Afib by the time they’re 80 years old.

Then there’s “Secondary Afib,” meaning the heart reacts to a trigger, such as an external insult. Once that provocation fades, so too does the Afib. Some examples of insults to the heart that can cause secondary Afib include alcohol intoxication, high fevers, extreme exhaustion, and too much caffeine. Other temporary conditions like a pulmonary embolus or chest surgery of any kind can also cause atrial fibrillation because the heart can become inflamed or irritated.

Be Aware of the Risk of Stroke

The single most severe risk of Afib is stroke. Patients with Afib are five times more likely to have a stroke than patients without it. Stroke is no joke. It can be debilitating and even deadly. Stroke is defined as the death of brain tissue that can result when a blood clot forms in the heart, breaks free, then lodges in a brain blood vessel, stopping the vital flow of oxygen and nutrients to brain cells. If the damage is small, mild symptoms, like weakness or minor visual loss, might occur.

But if the tissue damage is extensive, symptoms could be extremely serious, such as permanent blindness, paralysis, or even death. If the blood vessel blockage is temporary and resolves on its own (for instance, a small blood clot that travels to the brain then dissolves after a short period of blood vessel blockage), the condition is called a transient ischemic attack (TIA). In TIAs, brain tissue is injured but recovers, and the symptoms may be mild, for example, brief visual loss or speech slurring that gets better.

Strokes caused by AFib are twice as likely to kill patients and twice as likely to cripple them than strokes caused by other conditions. At MedStar Heart & Vascular Institute, our priority is our patients’ safety above all else. This compels us to put our full attention and effort into diagnosing atrial fibrillation in patients who may have it—and protecting them.

A Message for the Community

Our message is simple. Afib is serious, but it does not have to be scary. The body undergoes many changes as it ages, and an increasing risk of Afib is one of them. As our population gets older, more of us will develop it, so it is important that we be aware and ready, not upset or alarmed.

We ask that you recognize possible signs—an irregular pulse, feeling unusual fluttering within your chest, having noticeable reduction in your energy or ability to exert yourself physically. These should be addressed promptly by a healthcare team that you trust. If you witness or experience any signs of brain symptoms like sudden visual or speech changes, that is a medical emergency that requires an immediate call to 911.

Diagnosing and Dealing with Atrial Fibrillation

We now have many tools to detect atrial fibrillation, even if it happens infrequently, and to assess symptoms and risks, then treat patients accordingly. If changes to your heart rhythm or unusual symptoms like those described above develop, please see your doctor right away. Like so many conditions, this one is better managed the earlier it is addressed.

Our practitioners at MedStar Washington Hospital Center—whether primary care or internal medicine doctors, cardiologists, or heart rhythm specialists—are experts at dealing with heart rhythm disorders. Together, we’ll use the best tools, techniques, and scientific evidence to tailor our approach to the individual needs and risks of each of our patients. And we commit to follow the best science, practice with the best ethics, and deliver care with the greatest compassion.