Re: Atrial Fib sufferer

Posted By CCF CARDIO MD - CRC on March 02, 1999 at 14:38:44:

In Reply to: Atrial Fib sufferer posted by Al on March 02, 1999 at 13:24:58:






I'm trying to figure out why I get Atrial Fibrillation.  I was released from the hospital last night after a second occurance of a-fib.
I'm 29 years old,6' 180 lbs., male, and as far as I know, in good health. I try to make sure my levels of electrolytes(Mg & K) are high. I'm a  P.E. teacher and I jog or swim 5 days a week.
My first episode was when I was 26 (11-95).  I was put on 50mg Lopressor/day and remained on for 1 1/2 years.  In 5-97, I quit taking medication.
No problems until now.  Echocardiogram after 1st occurrance showed mitral valve prolapse.  Was a pretty heavy drinker during early and mid twenties.  
Also smoked 1-4 packs/week in early- mid 20's.  Currently don't smoke and drink only 2 beers a week, if at all.  Do not drink coffee, not many colas.
Any ideas on what causes me, at a young age, to suffer from this?  My main concern is that I won't be able to exercise.  I planned on participating in
4 or 5 roadraces/ triathlons per year.  Is it possible that I have some heart damage?  My doctors haven't given me any particular reason why this occurs.
I think its easier to deal with an illness if you know the reason that you suffer from it.
I will now be taking 25mg atenolol/day.
Thanks for any information.
Al





Dear Al,

Thank you for your question.  Atrial fibrillation is 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.  There are many potential cause for atrial fibrillation.  Some potential causes are: 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.
When no cause can be found the term "lone atrial fibrillation" is used.  This generally caries a better prognosis than other types of afib but is still a chronic condition.
There is no single method used in the treatment of lone afib.  In general, blood anticoagulation with warfarin is not recommended for those patients less than 60.  Treatment with antiarrhythmic drugs such as beta-blockers may or may not be indicated depending on the situation.

Prevention:
Follow your doctor'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.
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.
Q: Are there other safe drugs I could take at home to avoid cardioversion?
A: There are many different drugs that are used in the attempt to keep the heart in sinus rhythm (SR) but as with any medication they all have various side-effects.  You doctor can work with you on finding the best drug for your case.
Q:  It seems that the better physical shape I stay in the less I have a problem with A.F. Could exercise have an impact?
A: There is no known effect of exercise on atrial fibrillation (AF).
Q: Is a pacemaker an alternative?
A: In some people who are unable to be controlled with drugs the electrical connection between the atria (upper heart chambers) and ventricles (lower heart chambers) is electrically severed and a pacemaker is placed to control the ventricles.  The atria remain in fibrillation but the side effect of the rapid heart rate is eliminated.  Chronic anticoagulation is required, as there is a risk of blood clots forming in the atria.
Q:  I have an uncle that was diagnosed with IHSS. Are IHSS and Mitral valve prolapse related problems?
A: No.

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

I hope you find this information useful.  Information provided in the heart forum is for general purposes only.  Only your physician can provide specific diagnoses and therapies.  Please feel free to write back with additional questions.
If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter.  The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.