Atrial Fibrillation

When a healthy heart beats, the muscular walls of the heart contract and squeeze blood out and around the body.

In Atrial Fibrillation, the upper chambers of the heart (atria) contract randomly in a disorganised way (fibrillate). Sometimes this is so fast that the heart muscle cannot relax properly between contractions (squeezes/pumps). This reduces the heart’s efficiency and performance resulting in the symptoms.

Palpitations (being aware of your heartbeat)

• Tiredness
• Shortness of breath
• Dizziness or feeling faint

Having an irregular pulse could also be an indicator of AF. However, some people only have mild symptoms, or while other people have no symptoms at all.

AF may be detected by:

• feeling the pulse at the wrist (although this method can be unreliable)
• using home medical equipment e.g.:
• blood pressure machine (showing irregular pulse or the machine being unable to record your BP
• pulse oximeter (used to check oxygen levels, but may also reveal an irregular pulse)
• fitness devices worn on wrists can also pick up an irregular pulse

Some people have AF that comes and goes (paroxysmal). This means your pulse could feel normal sometimes and irregular at other times.

You can watch a video on how to check your pulse

If your pulse feels irregular or if you’re concerned in anyway about your pulse, you should make an appointment to see your GP.

If your GP suspects AF, they may refer you for further tests:

• An ECG (electrocardiogram) which is a simple test that records the rhythm and electricity of the heart
• Chest x-ray
• Blood tests
• An echocardiogram: a test like an ultrasound that shows how well your heart is pumping.

Causes include:

• Coronary heart disease (narrowing or blockage of arteries supplying the heart muscle)
• Overactive thyroid gland (hyperthyroidism)
• High blood pressure (“hypertension”)
• Heart valve disease
• Congenital heart disease
• Pericarditis (inflammation of the sac covering the heart)
• Cardiomyopathy (heart muscle problems)
• Diabetes
• Excess alcohol consumption

AF can also be associated with some other health conditions including:

• Pneumonia
• Chronic obstructive pulmonary disease (COPD)
• Lung cancer
• Asthma
• Pulmonary embolism

Not everyone with AF has an underlying condition. It can sometimes affect people who are physically very fit, such as athletes.

Certain situations can trigger an episode of AF, including:

• Excessive amounts of alcohol and binge drinking
• Being overweight
• Smoking
• Drinking lots of caffeine such as tea, coffee and energy drinks
• Taking illegal drugs particularly amphetamines and cocaine

You can answer some questions to assess how healthy your heart is likely to be and get some advice about how you could improve it here.

People with AF are at an increased risk of having a stroke, or very occasionally heart failure.

Risk of stroke also depends on other factors including age, and whether you have conditions such as high blood pressure, heart failure, diabetes, or previous blood clots.

If your AF is persistent, it may begin to weaken the heart, and in rare cases, this may lead to heart failure.

Treating AF can reduce your risk of stroke and other complications.
It is therefore important to make an appointment with your GP if you think you may have AF.

Most people with AF are prescribed medications to help control their heartbeat.

These medications are used to:

• Control the heartbeat: usually beta-blockers and anti-arrhythmic drugs.
• Reduce your risk of stroke: blood thinners (anticoagulants) to help reduce their risk of stroke. In the past the main anticoagulant used was warfarin and this requires regular blood tests to check the level of anticoagulation and adjust the dose. Nowadays many people can take one of the newer anticoagulants (Direct Oral Anticoagulant or DOAC) which have a fixed dose and so these are easier to manage.

The doctor will discuss which medication options are most appropriate for you after calculating your risk of having a stroke using an algorithm based on your risk factors.

Occasionally other treatments are more appropriate including:

• Ablation
• Cardioversion
• Having a pacemaker fitted

Other medication to reduce your risk of stroke may be advised. This includes medication to reduce your blood pressure, reduce your cholesterol and, if you have diabetes, to control your blood sugar.

In addition to medication, living a healthy lifestyle can further reduce your risk of having a stroke. This includes:

• Eat healthily
• Be physically active
• Keep to a healthy weight and lose weight if necessary
• Don’t smoke
• Cut down on alcohol and caffeine

You can read more about medications and further treatments by visiting the NHS website and The British Heart Foundation website

You condition is usually managed and monitored by your GP. Only a small number of patients need further specialist input and are referred on to a cardiology team.

• British Heart Foundation’s atrial fibrillation booklet
• British Heart Foundation’s heart matters magazine story

Useful information about my AF

Use the links below to access some useful guides from the British Heart Foundation:

• Quick guide to atrial fibrillation
• Living with atrial fibrillation

What is atrial fibrillation | https://www.bhf.org.uk

British Heart Foundation | published on 25 November 2015