Afib – The Sometimes Silent Killer

peverley_photoWhat is afib?


Afib, short for atrial fibrillation, is a cardiac arrhythmia originating in the atria of the heart.   It occurs when the atria, the top chambers of the heart, quiver or “fibrillate” instead of squeezing and pumping normally.  80% of the blood in the atria usually passively falls into the ventricles when the bicuspid and tricuspid valves open.   But because, in afib, the atria quiver and don’t squeeze, the blood does not get that extra push it usually would with the atrial squeeze.  This is referred to as loss of the “atrial kick”.



What are the symptoms?

Many times atrial fibrillation has no symptoms at all and it is incidentally picked up when a routine EKG is performed.   This is how hockey player Dallas Stars’ center Rich Peverly found his afib recently.  Atrial fib shows up on the EKG as an irregular heartbeat with fibrillating lines and waves where the P waves should be.  It can be a slow rate or a fast rate depending on how frequently the ventricles respond to the stimuli given off by the atria.  If they respond more frequently, the rate can become very fast and turn into atrial fibrillation with rapid ventricular response of afib with RVR.  Depending on how fast the rate is, the condition can become serious and need a medical intervention.  Other symptoms of atrial fibrillation: heart palpitations or “fluttering”, dizziness, faintness, syncope or passing out, and chest pain.  If someone goes on with untreated afib for a long time they may begin to show other symptoms like shortness of breath, inability to perform activities they usually could due to fatigue, and lower extremity swelling.

What are the causes?

There are several cardiovascular diseases and/or conditions that atrial fibrillation is linked to and associated with, including:  high blood pressure, coronary artery disease, mitral valve issues, pericarditis, congenital heart disease, previous heart surgery.  Some lung diseases are linked also, including pneumonia, lung cancer, pulmonary embolism, and sarcoidosis.  Atrial fib has also been linked to hyperthyroidism and family history of afib.

What are the complications?

Several complications can arrive from atrial fib.  The first being the heart rate fluctuation and irritability discussed earlier.  It also causes turbulence of the blood inside the heart’s atria.  The body sees this turbulence as almost like an injury and sends platelets there.  This accumulation of platelets causes clots to form in the atria.  These clots then get pumped through the heart and can get sent to the lung causing what’s called a pulmonary embolus or the brain causing a stroke.  Another complication of atrial fib, if left untreated for a long time can lead to congestive heart failure- this causes the symptoms mentioned earlier including the swelling, shortness of breath, activity intolerance, etc.

How is it treated?

Atrial fibrillation is a manageable condition, depending on the case, as each person is different.  As far as management, there are a number of medications to help control the heart rate and even the rhythm.  These include drug classes like Beta-blockers, calcium-channel blockers, and cardiac glycosides.  A person with chronic atrial fib may also be put on a form of anticoagulant like Coumadin, Plavix, Aspirin, or Lovenox to help keep their blood from clotting too easily in order to prevent stroke or pulmonary embolus.  Another way to treat and sometimes get rid of afib is to use cardioversion.  Cardioversion can be done electrically using a machine the mildly shocks the heart back into a normal rhythm using its sinus node instead of the atria to pace the heart and send the signals (this is how Rich Peverly treated his) or it can be done chemically using medications that do the same thing.

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