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Atrial Fibrillation-O-Rama

Atrial fibrillation affects around one million people in the UK alone and is more likely as we age. Affecting seven in 100 of the over-65’s, it is more common in those with high blood pressure, heart valve problems and other types of heart disease.

Atrial fibrillation is the most common heart disorder causing an irregular and often abnormally fast heart rate. Diabetes and atrial fibrillation can co-exist and can lead to significant cardiovascular outcomes, insulin resistance and inflammation.

Hyperglycemia leading to atrial fibrosis, changes atrial size and diastolic dysfunction.

Your heart should normally beat regularly, between 60 to 100 beats a minute when resting. In atrial fibrillation, the heart rate is irregular and can be very fast (over 100 or even 150 beats per minute), although between episodes it will settle. You may not notice the irregular heartbeat initially, with no symptoms for several months before, then experiencing episodes due to triggers such as alcohol or caffeine, or stress.

After a while it becomes permanently fast and irregular, resulting in heart failure as the heart becomes a less efficient pump, unable to effectively move blood round the body. Symptoms such as breathlessness, tiredness, ankle swelling, palpitations or dizziness become noticeable. The irregular movement of the heart muscle also puts you at risk of small clots, which can cause a stroke.

The Cause

Atrial fibrillation (AF) is caused when abnormal electrical impulses start firing in the top chambers of the heart, overriding the natural pacemaker and making it contract irregularly. It’s not well understood, but it’s partly due to age and is linked to other heart disease such as atherosclerosis.

Treatment includes medication to control the heart rhythm, blood-thinning medication to prevent clots and if this doesn’t solve the problem, surgical techniques may be needed, including ‘cardioversion’, where an electric shock is put through the heart to return the rhythm to normal and ‘catheter ablation’, where the area of the atrium causing the irregular activity is destroyed using local treatment on the end of a cardiac catheter. In some cases a pacemaker may need to be surgically fitted in order to keep the heartbeat regular.

The treatment of atrial fibrillation in those with diabetes, similar to those without diabetes, involves improving cardiac function through rate and or rhythm control, but also risk stratifying the potential for thromboembolism.

The Outlook

Treatment with direct oral anticoagulants (direct thrombin or factor Xa inhibition) has revolutionised treatment of thromboembolic risk in atrial fibrillation including in those with diabetes.

Without treatment you are at risk of both a stroke and a gradual failure of your heart as a pump, slowing you down and risking a heart attack, but after treatment you should be able to return to a normal lifestyle.

A similar condition, called atrial flutter, has less chaotic electrical impulses and is usually directly treated with catheter ablation.

Things to Remember

  • Your pulse can have a natural variation in rate as you breathe in and out (called sinus rhythm), but if you feel a fast irregular beat you should talk to your doctor.
  • Chest pains should always be reported urgently and investigated, especially if you have any breathlessness, pain in the arm, sweating or swelling of your feet.
  • Blood-thinning medication previously meant only warfarin, but now newer medicines are commonly used, which are more reliable and don’t need regular blood tests.
  • Cardioversion and catheter ablation may be done as a day patient and are usually permanent solutions to AF.

Healthy Eggs

Previous advice varied over whether eggs are unhealthy. The salmonella scare has gone now chickens are vaccinated, but the cholesterol debate continues — a large study of 30, 000 people reported in The American Medical journal found that for every half an egg eaten per week, your risk of heart disease increases by 6%. Current guidelines in the UK still say eat eggs in moderation (three to four eggs a week is fine), but watch out for further studies.

4 Fixes for Poor Sleep

  1. Prepare your bedroom. Make sure you have a comfy warm bed but in a dark, cool room with some air flow without any distractions (TV or computer).
  2. Turn off any lights. Especially blue light from gadgets, as this can affect the brain’s sleep centre. Try to turn off smart phones, tablets and laptops an hour before bed so sleep isn’t impaired.
  3. Avoid large meals and don’t drink too much tea, coffee or alcohol after 7pm. They all have stimulant effects and may also make you get up in the night.
  4. Wind down. Try to do any physical activity earlier in the day, making sure you get time to ‘wind down’ physically and mentally with quieter activities through the evening.

E349 – Atrial Fibrillation –

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