Subject: Re: Atrial Fibrilation
Forum: The Heart Forum
Topic Area: Heart Murmur
Posted by CCF CARDIO MD - CRC on July 31, 1998 at 16:26:25:
In Reply to: Atrial Fibrilation posted by Dan on July 29, 1998 at 22:12:14:

I have been going to a cardiologist for the past 10 years. After doing many tests, which I must do yearly, he said that I have a very healthy heart and that my atrial fibrilation is caused by "electrical" problems and it is nothing serious. He has me taking 120 mg. of Betapace a day. This seems to help but I still get episodes every once in a while. These is Not just a case of a little flutter. This is quite an irregular heart beat that will not go back to normal. I recently had to go the doctor to get IV drugs to get my heart back to normal. I have had to do this a few times before but it has been over a year.

Any thoughts or comments would be appreciated.
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Dear Dan,

Thank you for your question. Afib is a chronic problem and as of now there is no cure. Hopefully in the not too distant future we will be able to cure afib but until then medication is about the best treatment. The following information below should help you with any additional questions you may have.

Atrial fibrillation
Definition:
A disorder of heart rate and rhythm in which the upper heart chambers (atria) are stimulated to contract in a very rapid and/or disorganized manner; this usually also affects contraction of the ventricles.

Causes, incidence, and risk factors:
Arrhythmias are caused by a disruption of the normal functioning of the electrical conduction system of the heart. Normally, the atria and ventricles contract in a coordinated manner. In atrial fibrillation and flutter, the atria are stimulated to contract very quickly. This results in ineffective and uncoordinated contraction of the atria.

The impulses may be transmitted to the ventricles in an irregular fashion, or only some of the impulses may be transmitted. This causes the ventricles to beat more rapidly than normal, resulting in a rapid or irregular pulse. The ventricles may fail to pump enough blood to meet the needs of the body.

Causes of atrial fibrillation and flutter include dysfunction of the sinus node (the "natural pacemaker" of the heart) and a number of heart and lung disorders including coronary artery disease, rheumatic heart disease, mitral valve disorders, pericarditis, and others. Hyperthyroidism, hypertension, and other diseases can cause arrhythmias, as can recent heavy alcohol use (binge drinking). Some cases have no identifiable cause. Atrial flutter is most often associated with a heart attack (myocardial infarction) or surgery on the heart.

Atrial fibrillation or flutter affects about 5 out of 1000 people. It can affect either sex. Atrial fibrillation is very common in the elderly, but it can occur in persons of any age.

Prevention:
Follow the health care provider's recommendations for the treatment of underlying disorders. Avoid binge drinking.

Symptoms:

sensation of feeling heart beat (palpitations)
pulse may feel rapid, racing, pounding, fluttering,
pulse may feel regular or irregular
dizziness, lightheadedness
fainting
confusion
fatigue
shortness of breath
breathing difficulty, lying down
sensation of tightness in the chest

Note: Symptoms may begin and/or stop suddenly.

Signs and tests:
Listening with a stethoscope (auscultation) of the heart shows a rapid or irregular rhythm. The pulse may feel rapid or irregular. The normal heart rate is 60 to 100, but in atrial fibrillation/flutter
the heart rate may be 100 to 175. Blood pressure may be normal or low.

An ECG shows atrial fibrillation or atrial flutter. Continuous ambulatory cardiac monitoring--Holter monitor (24 hour test)-- may be necessary because the condition is often sporadic (sudden beginning and ending of episodes of the arrhythmia).

Tests to determine the cause may include:

an echocardiogram
a coronary angiography (rarely)
an exercise treadmill ECG

Treatment:
Treatment varies depending on the cause of the atrial fibrillation or flutter. Medication may include digitalis or other medications that slow the heart beat or that slow conduction of the impulse
to the ventricles.

Electrical cardioversion may be required to convert the arrhythmia to normal (sinus) rhythm.

Expectations (prognosis):
The disorder is usually controllable with treatment. Atrial fibrillation may become a chronic condition. Atrial flutter is usually a short-term problem.

Complications:

incomplete emptying of the atria which can reduce the amount of blood the heart can pump
emboli to the brain (stroke) or elsewhere--rare

Calling your health care provider:
Call your health care provider if symptoms indicate atrial
fibrillation or flutter may be present.

The links below are good sources of information about atrial fibrillation.

http://www.med-edu.com/patient/arrhythmia/atrial-fib.html
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/afib.html
http://www.merck.com/!!vDXoe16kTvDXpz08Of/pubs/mmanual_home/chapt16.htm

Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist.

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