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Heart Rhythm (Expert Forum)
Atrial Fib
Answered by
Michael J. McWilliams, M.D. - atrial fibrillation, Pacemakers, Defibrillators, Arrhythmias (SVT, VT), PVC/PAC, Ablation
Wilmington Health Associates
Wilmington - NC
Questions in the Heart Rhythm forum cover topics that include heart rhythm issues, arrhythmia, irregular heartbeat, implanted defibrillators, pacemakers, and tachycardia.
Atrial Fib
by fritziematt, Oct 13, 2007 06:07PM
Hello
I'm 28 years old, male. I had a bout of atrial fib once a few months ago. I had it for maybe two or three hours. I think it was stress that caused it. It had been building up for a while. My ER doc. said he wasn't going to give me meds because I was young and would probably never have the problem again. I had an echocardiogram later in that month and everything was normal according to the report. Atria were normal size. Blood ejection volume was normal etc. I also had a heart event monitor which showed no atrial fib for the month after my episode. My GP doctor (not a heart specialist) said that he was happy with the results and decided not to do anything. I'm on 81mg of aspirin and also atenolol for high blood pressure. My cholestrol test are very good, and I have no diabetes. I am still very worried about stroke though. I have seen a lot of horror stories online about younger people having strokes. What is my risk for stroke? I don't think I've been in atrial fib since that one time. I'm also wondering how doctors decide what meds for clots to put you on? Is it age? and underlying heart disease? High Cholestrol? When is warfarin used and when is just aspirin used? Is 81 mg of aspirin enough for someone in my situation? Also if I have had atrial fib once in the past is it a good idea to get checked for it again? How often? These questions have been lingering in my head and I have had a lot of anxiety over them. Any answers would be great!
Thanks for your help!
~Matt
I'm 28 years old, male. I had a bout of atrial fib once a few months ago. I had it for maybe two or three hours. I think it was stress that caused it. It had been building up for a while. My ER doc. said he wasn't going to give me meds because I was young and would probably never have the problem again. I had an echocardiogram later in that month and everything was normal according to the report. Atria were normal size. Blood ejection volume was normal etc. I also had a heart event monitor which showed no atrial fib for the month after my episode. My GP doctor (not a heart specialist) said that he was happy with the results and decided not to do anything. I'm on 81mg of aspirin and also atenolol for high blood pressure. My cholestrol test are very good, and I have no diabetes. I am still very worried about stroke though. I have seen a lot of horror stories online about younger people having strokes. What is my risk for stroke? I don't think I've been in atrial fib since that one time. I'm also wondering how doctors decide what meds for clots to put you on? Is it age? and underlying heart disease? High Cholestrol? When is warfarin used and when is just aspirin used? Is 81 mg of aspirin enough for someone in my situation? Also if I have had atrial fib once in the past is it a good idea to get checked for it again? How often? These questions have been lingering in my head and I have had a lot of anxiety over them. Any answers would be great!
Thanks for your help!
~Matt
Doctor's Answer
by Michael J. McWilliams, M.D., Oct 13, 2007 07:28PM
, Oct 13, 2007 07:28PM
Hi Matt,
I understand your concerns. There is an article in the Cleveland Clinic Journal of Medicine that addresses these issues in detail.
http://www.ccjm.org/PDFFILES/Fitzgeraldsuppl4_05.pdf
Your risk of stroke is calculated by looking at your risk factors and the acronym CHADS2
Congestive heart failure 1 point
Hypertension 1 point
Age greater than 75 1 point
Diabetes 1 point
Stroke or transient ischemic attack (stroke with symptoms that last less than 24 hours) 2 points
If you have 0-1 point, your risk of strike low and the risk of bleeding with coumadin is greater than the risk of stroke --- therefore aspirin is sufficient. Coumadin can be considered, but aspirin is usually recommended. If you have more 2 or more points, coumadin is recommended. It sounds like you have one point (hypertension).
Your risk of stroke is calculated at 2.8% per year or 2.8 per 100 patient years.
81 mg is sufficient for aspirin.
If you had symptoms with your atrial fibrillation, it is likely that you will have symptoms again. I would not do random screening for it.
If you really want help falling a sleep at night, this is the guideline statement for treatment of atrial fibrillation.
http://circ.ahajournals.org/cgi/reprint/114/7/700 (short cut)
http://circ.ahajournals.org/cgi/content/full/114/7/700 (on the right side you will see where it says print pdf -- hit hit link if the above links don't work
My office website discusses basics of atrial fibrillation and treatment in a more watered down version than the guidelines statement.
http://www.afib.whaclinic.com/understanding-afib.htm
I hope this answers your questions. thanks for posting.
I understand your concerns. There is an article in the Cleveland Clinic Journal of Medicine that addresses these issues in detail.
http://www.ccjm.org/PDFFILES/Fitzgeraldsuppl4_05.pdf
Your risk of stroke is calculated by looking at your risk factors and the acronym CHADS2
Congestive heart failure 1 point
Hypertension 1 point
Age greater than 75 1 point
Diabetes 1 point
Stroke or transient ischemic attack (stroke with symptoms that last less than 24 hours) 2 points
If you have 0-1 point, your risk of strike low and the risk of bleeding with coumadin is greater than the risk of stroke --- therefore aspirin is sufficient. Coumadin can be considered, but aspirin is usually recommended. If you have more 2 or more points, coumadin is recommended. It sounds like you have one point (hypertension).
Your risk of stroke is calculated at 2.8% per year or 2.8 per 100 patient years.
81 mg is sufficient for aspirin.
If you had symptoms with your atrial fibrillation, it is likely that you will have symptoms again. I would not do random screening for it.
If you really want help falling a sleep at night, this is the guideline statement for treatment of atrial fibrillation.
http://circ.ahajournals.org/cgi/reprint/114/7/700 (short cut)
http://circ.ahajournals.org/cgi/content/full/114/7/700 (on the right side you will see where it says print pdf -- hit hit link if the above links don't work
My office website discusses basics of atrial fibrillation and treatment in a more watered down version than the guidelines statement.
http://www.afib.whaclinic.com/understanding-afib.htm
I hope this answers your questions. thanks for posting.
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My BP is well below 120/80 now with the 50mg of atenolol. Its usually under 110/70.
I had a really fast heart rate and strong palpitations when I had my episode. So unless I get atrial fib again I'm not going to be too concerned about stroke. I will keep taking aspirin even though it doesn't seem to help with Atrial Fib related strokes. Reducing my risk for other strokes is still a good idea. Anyway it looks like there are a lot of new ways to cure atrial fib if it comes back again and gets worse.