Atrial fibrillation (AF) is one of the most common cardiac arrhythmia encountered in our practices. It affects 2.2 million people in the United States who are older than 50 years of age. Urgent recognition and intervention is required to prevent its consequences. Failure to treat promptly can lead to stroke, heart attack, and sudden death.
AF is a common problem in cardiac patients. People have one in four lifetime risk after age forty of having AF. In AF patient’s atrium and ventricle are not in sync causing ineffective contraction of the heart. AF has clinical importance related to loss of atrial contractility, inappropriately fast ventricle response, loss of atrial contractility and emptying leading to the risk of clot formation and subsequently thromboembolic event. Patient will usually complain of palpitation, chest pain or pressure, shortness of breath and generalised weakness.
Most common cause of AF is coronary artery disease, valvar heart disease, hypertension, diabetes, hyperthyroidism, COPD, pulmonary embolism, and sleep apnea. Caffeine, cigarette smoking and binge drinking can set off AF.
Risk factors for AF include previous strokes, Tran’s ischemic attack, mitral stenosis, hypertension, and diabetes, age more than 75 and left ventricular dysfunction. Stroke rate in-patient with cardiovascular disease (CVD) can be 5 to 12 per cent.
Patients with new onset AF with rapid ventricular response are admitted to the hospital with monitored bed. Blood work is drawn. Cardiac enzymes, electrocardiogram is done to rule out any heart attack and rhythm abnormalities and chemistries to rule out hyperthyroidism and electrolytes abnormalities. Chest X-ray is also done to rule out congestive heart failure. Patients are started on blood thinner to prevent stroke. Echocardiogram is performed to diagnose functional or valvular abnormalities. Cardiologist is consulted for work up including any stress test and cardiac catheterisation if required or medication for conversion to normal sinus rhythm.
Mortality rates were high with Cardiovascular Disease range from 19 to 52 per cent, which is 5 to 10 times higher than that with a person without CVD. Two-thirds of stroke events could be averted by anticoagulation with warfarin. The cost of stroke can be enormous since patients may need long term hospital care, skilled nursing facilities, home health care, and frequent follow up.
People who have valvular heart disease and end stage renal disease need to be treated with warfarin. Patients with non-valvular heart disease and Treatment with warfarin can reduce the risk of stroke by 60 to 70 per cent. AF can be treated with warfarin or pills (Apixaban, Dabigatran, Rivaroxaban). Side effect of these medications will include risk of gastrointestinal or intracerebral bleeding.
AF is a serious medical condition that requires prompt treatment. Delay in management can result in stroke, heart attack, and sudden death.
[ANIS ANSARI, MD, FASN is Chairman, department of Medicine, Mercy Medical Center, Clinton, Iowa, USA]