Marsha, 78, recently had a second mild stroke, prompting her doctor to refer her to a cardiologist. Marsha is physically active, does not have any chronic medical problems, eats a nutritious diet, and maintains a healthy weight. Marsha agreed to see the cardiologist, but wondered why someone with her medical history would need an evaluation.
Marsha’s cardiologist scheduled an EKG to assess her heart rhythm and an echocardiogram, an ultrasound to look at the structure of her heart, before the appointment. Neither test revealed any abnormalities. Since her cardiologist suspected that atrial fibrillation was the cause of her strokes, the next step was to schedule a 24-hour Holter monitor.
The Holter monitor showed that Marsha’s heart went into atrial fibrillation several times during the day. The cardiologist prescribed medications to control her heart rhythm and decrease her risk of blood clots. Unfortunately, Marsha had another stroke. With no family nearby, it was clear that Marsha needed help if she wanted to continue to live independently.
What is the relationship between atrial fibrillation and stroke?
The heart has two upper chambers (atria) and two lower chambers (ventricles). The SA node, a specialized area of the heart, regulates the heartbeat’s rhythm. The electrical impulse travels across the atria and into the ventricles. The electrical impulse stimulates the heart muscle to contract, beginning with the atria and progressing to the ventricles. When perfectly timed, the heart functions as an efficient pump.
When electrical conduction starts in another part of the heart, or even in multiple parts of the heart simultaneously, an arrhythmia can occur. These chaotic impulses make coordinated contraction of the atria impossible.
Normally, the SA node adjusts its firing rate in response to physical activity. During the day, heart rate varies depending on activity levels. Typically, the heart rate at rest is between 60 and 80 beats per minute. However, with atrial fibrillation, the impulses in the atria can increase to 300 to 600 beats per minute.
Atrial fibrillation is an abnormal heart rhythm that makes the atria quiver instead of contract. Blood pools in the atria. Blood pooling in the atria increases the risk for blood clots to develop. If one of these blood clots breaks free and travels to the brain, it can cause a stroke.
Atrial fibrillation affects up to 2.2 million Americans, and it increases their risk of having a stroke by four to six times.
What are the symptoms of atrial fibrillation?
Some people may not notice any symptoms of atrial fibrillation, and like Marsha, are diagnosed after they have a stroke. According to the American Heart Association, symptoms of atrial fibrillation may include:
- Quivering or fluttering feeling in the chest
- Irregular heartbeat
- Overall fatigue or fatigue when exercising
- Dizziness
- Shortness of breath
- Feelings of anxiety
- Weakness
- Sweating
Who’s at risk for atrial fibrillation?
Atrial fibrillation does not have a single cause, and in many cases, a cause is not found. Potential causes may include:
- Heart failure
- Heart surgery
- Cardiomyopathy
- Coronary artery disease
- Congenital heart disease
- High blood pressure
- Pulmonary embolism
Non-heart-related factors that may increase the risk include:
- Excessive alcohol use
- Excessive caffeine use
- Stress
- Medications
- Metabolic abnormalities
- Electrolyte abnormalities
- Infections
- Sleep apnea
- Hyperthyroidism
How is atrial fibrillation diagnosed?
Since atrial fibrillation is an arrhythmia, diagnosing it is straightforward as long as the test is performed during an episode of atrial fibrillation. Atrial fibrillation can occur periodically or be persistent. If it occurs periodically, it is possible to have testing be completely normal in between episodes.
An electrocardiogram (ECG) is a test that records the electrical activity in the heart. Electrical sensors are attached to the skin across the chest and arms, and legs. The test only takes a few minutes to run and can easily be completed in a doctor’s office.
If an EKG is normal and symptoms of atrial fibrillation are periodic, the next step in testing is to monitor for a longer period using a Holter monitor. This wearable sensor can be worn for several days to weeks. It can record the rhythm continuously, or the user can trigger a recording when they experience symptoms.
How is atrial fibrillation treated?
The treatment strategy for atrial fibrillation is two-pronged: control the heart rate and prevent blood clotting. Medications can slow the heart rate overall or prevent atrial fibrillation from developing.
Warfarin is the classic medication used to prevent blood clots. Newer anticoagulant drugs inhibit specific clotting factors and prevent clots from developing. These newer medications do not require blood tests or dietary restrictions.
What is the life expectancy of someone with atrial fibrillation?
The prevalence of atrial fibrillation increases with age, as does the risk of mortality from atrial fibrillation. Atrial fibrillation independently increases the risk of death. The highest risk is in the year after diagnosis. Risk varies from 1.6% to 4.2% per year.
Atrial fibrillation is more common in men, but the mortality risk is higher in women. Several factors may increase the risk of dying from atrial fibrillation, including strokes, medication side effects, comorbid diseases, and heart disease. In a study that evaluated risk in patients 55 to 74 years, the 10-year mortality rate was 61.5% in men with atrial fibrillation compared to 30% in men without. Women in the same age range had a 10-year mortality rate of 57.6% with atrial fibrillation compared to a 20.9% rate without.
Atrial fibrillation can lead to serious complications, such as stroke. However, early diagnosis and treatment can reduce the risk.
How can home healthcare help with atrial fibrillation?
Unfortunately, Marsha has already had several minor strokes that have limited her independence. However, she is otherwise fit and active. Marsha contacted Sunland Home Care & Medical to inquire about services that can help her remain active while living at home. Since she is taking Warfarin, she arranged for INR monitoring at home, so she does not need to go to her local hospital lab for blood tests. She also arranged for transportation to medical and social appointments and help with basic housekeeping and cooking chores.
Sunland Home Care & Medical can:
- Provide transportation to medical and personal appointments
- Administer medications
- INR monitoring
- Do light housekeeping
- Prepare meals
- Assist with personal care
- Do fall and balance assessments
- Create short- and long-term care plans
