What is that funny feeling in your chest mean?
You are going about your day when you notice that your chest fells weird and your heart feels like it is racing. This lasts for a few minutes, but then it goes away. What is going on? Will that odd sensation come back? Should you see a doctor?
Atrial Fibrillation (AFib) is an irregular and often rapid heart rate. Your heart’s natural pacemaker, sinus node, resides in the upper right part of your heart and the impulse that starts each heart beat originates here. It is the only part that controls the rate of the two upper chambers (atria) of your heart. The electrical impulse travels from the sinus node through the atria causing them to contract sending blood from them into the lower chambers (ventricles) of the heart. The impulse then reaches the atrioventricular (AV) node which then transmits the signal to the ventricles causing them to contract and send blood throughout your body. This slight delay in the signal allows the atria to relax and refill with blood as the ventricles contract. During AFib, the sinus node malfunctions causing it to rapidly send signals to the atria to contract at an increased rate. The muscles of the atria are unable to actually do this due the speed at which the signals are being transmitted, so they end up quivering instead. The signals get sent to the AV node as well, but not all of them get through. This means the ventricles will contract more rapidly than normal, but not as fast as the atria. The problem with the atria not having time to contract and just quivering, is that the blood can pool in them and start to clot. These clots are the major concern because they can end up traveling through your bloodstream and reach your brain, lungs or somewhere else causing you to have stroke, pulmonary embolism, or blockage elsewhere in your body.
Typically, AFib is caused by an abnormality or damage to your heart’s structure. Some of the most common reasons are hypertension, heart attack, coronary artery disease, abnormal heart valves, congenital (you were born with) heart defects, overactive thyroid gland, metabolic imbalance, sleep apnea and exposure to stimulants. Some people have lone AFib, which means they do not have any heart defects or damage and the cause is unclear. You might hear the term atrial flutter (AFlutter). It is a heart rhythm that is similar to AFib but looks more organized on an electrocardiogram (EKG) because it has a more normal pattern. Sometimes, AFlutter turns into AFib or vice versa. They have the same symptoms, causes and treatments.
Most people with AFib complain of having palpitations, which they describe as a racing, uncomfortable or flip-flopping sensation in their chest. Other symptoms include irregular heartbeat, weakness, reduced ability to exercise, fatigue, lightheadedness, dizziness, confusion, shortness of breath and/or chest pain. In some cases, people don’t have any symptoms and AFib is found on a physical exam or EKG. Typically, it is diagnosed by having an EKG done in order to see the very distinct pattern. AFib can be constant or episodic with symptoms lasting a few minutes to a few hours. If your heart doesn’t return to it’s normal rhythm on its own, then you need to seek immediate medical treatment. For some people, their heart rate does not ever convert out of AFib and therefore need to be managed with medications for the rest of their life.
The treatment for AFib is based off of numerous factors, such as the length of time that you have had it, how bad the symptoms are and the underlying cause. The main goal of treatment is to reset the heart rhythm or at least control the rate and prevent blood clots to decrease the risk of stroke or other serious complications. In order to reset your heart rhythm, the doctor does something called a cardioversion and usually does it one of two ways. The first is to deliver an electric shock to your heart through patches placed on your chest. This shock will momentarily stop the electrical activity within your heart. The thought is that when your heart’s electrical activity restarts, it will start at a normal rate. Usually this is done with some sedation so you don’t feel the shock as much. Also, the doctor may give you medicine to help your heart return to a normal (sinus) rhythm prior to delivering the shock. These medications are anti-arrhythmics and are given either by mouth or intravenously (IV). The second way to do cardioversion is with using just anti-arrhythmics on their own without any shocks. Both of these are done in a hospital under continuous heart monitoring. Usually, you will be prescribed one of the medications to take at home to prevent the likelihood of reoccurrence.
Sometimes, the need for cardioversion is not emergent and your doctor might have you take a blood thinner for several weeks prior to decrease the chance of blood clots and stroke. If this is the case, you will most likely continue the blood thinner for a period of time after the cardioversion. If your AFib can not be converted to a normal heart rhythm, the next concern is control your heart rate and prevention of blood clots. Most likely, your doctor will prescribe an anti-arrhythmic, blood thinner, heart rate control medication or some combination thereof. One other option, if your doctor is concerned that medication is not providing you with the best treatment, is an ablation which is done by several different methods. The bottom line is that the cells that are sending the signal to rapid contract are prevented from doing so.
The best prevention of AFib is to prevent as many of the diseases processes that can cause it as possible. This means living a heart-healthy lifestyle that helps keep your blood pressure and cholesterol in control. You can do this by choosing a diet that promotes this and having an increased amount of physical activity in order to maintain a healthy weight. This lifestyle also means avoiding smoking and limiting/avoiding alcohol and caffeine. It is important to reduce stress as this, or intense anger, can cause irregular heart rhythms. Another thing to consider is the use of over-the-counter cough/cold medications because some contain stimulants that can cause a rapid heart rate.
Atrial Fibrillation can be a scary experience, but it can definitely be corrected or managed with the right medical treatment. If you have any questions about or concerns that you might have AFib, please talk with your doctor. If you would like to learn more about it, please visit the American Heart Association’s Atrial Fibrillation page at http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/What-is-Atrial-Fibrillation-AFib-or-AF_UCM_423748_Article.jsp#.WnfZ3kxFzIU