Originally published in January, 2012.
Richard Brandt is an active man. He bikes as much as 30 miles every day during the warmer months and lifts weights regularly — if not daily. He eats a well balanced but not always perfect diet. Richard loves his sweets. He and his wife, Anne, have lived in Palos Heights for 45 years, in the very first home they purchased together. Together, the couple keep themselves busy by volunteering.
At age 73, Richard is in great shape and great health. His blood pressure and cholesterol are both very good, and his heart is strong. He takes only three prescription medications a day, and two are for an enlarged prostate. The third? Well, that fluctuates, much like his heart rate, but he keeps close tabs on both.
Richard has been keeping a diary to document his atrial fibrillation since he experienced his first attack nearly five years ago. The day was Tuesday, April 24, 2007, and he still remembers it vividly. “I was working out in the basement, and this thing hit. I didn’t know what it was. My heart was bouncing and jumping around. It felt like it was going to jump out of my chest. That particular day I was supposed to wash a woman’s windows, and when I got there, I had zero energy.”
Atrial fibrillation, or AF, is an abnormal heart rhythm that results in a rapid and erratic heart rate, typically over a sustained period of time. Richard has often experienced heart rates in excess of 100 beats per minute (bpm), and his first attack lasted six hours. Despite seeking immediate medical treatment, they kept coming at a rate of one or two a month. While AF in and of itself isn’t dangerous, it can be extremely debilitating and even frightening, and it also can raise your risks for some far more serious complications, namely heart attack and stroke. Although AF is not completely curable, it is treatable. With proper medical care and a great deal of education and self-monitoring, Richard now often goes six months or more between attacks. The key to treating the condition is first diagnosing it, and then understanding what triggers AF so you can take steps to prevent it.
Atrial fibrillation is an electrical complication of the heart. There are four chambers in the human heart – the two upper are called atria and the two lower are ventricles. Within the upper right chamber is a group of cells called the sinus node. This is your heart’s natural pacemaker. The sinus node produces the electrical impulse that starts each heartbeat.
Normally, this impulse travels first through the atria and then through a connecting pathway between the upper and lower chambers called the atrioventricular (AV) node. As the signal passes through the atria, the upper chambers contract, pumping blood from your atria into the ventricles below. As the signal passes through the AV node, the ventricles then contract, pumping blood out to the rest of your body. In atrial fibrillation, the upper chambers — atria — receive chaotic electrical signals from the sinus node. As a result, they quiver, as opposed to beat. The AV node between the two chambers then becomes overloaded, so the ventricles beat rapidly as well, but not as rapidly as the atria. Atrial flutter is similar to AF, but the rhythm is more organized and less chaotic.
“Atrial fibrillation is the most common form of heart arrhythmia,” explains Dr. Sean Tierney, a cardiac electrophysiologist in Palos Heights. “It results from the chaotic and irregular beating of the top chambers of the heart, caused by rapid firing of the sinus node. What dictates how you feel is how fast the bottom chambers are pumping,” Dr. Tierney continues. The normal range for a heart rate is between 60 and 100 beats per minute. The heart rate in AF may range from 100 to 175 bpm.
Overloading the Circuit
April 30, 2008: Typical attack started at 7:15 p.m. with erratic heartbeat. I took two Flecainide tablets at 7:30 p.m. At 8:30, beat was still erratic and I had that “washed out” feeling of no energy.
A heart in AF does not beat efficiently. The rapid quivering of the lower chambers makes it difficult for the heart to pump adequate amounts of blood to the rest of the body. The reduced blood supply can cause a variety of symptoms. Some of the most common symptoms of AF include:
- Palpitations, which are sensations of a racing, uncomfortable and irregular heartbeat, or a flopping in your chest
- Decreased blood pressure
- Shortness of breath
- Chest pain
Most people who have AF experience some degree of symptoms, but they may be as mild as simple fatigue or low-grade anxiety. “You may feel your heart racing or even pounding, especially at night,” says Dr. Tierney. “AF can keep you awake. You may feel exhausted when going up a flight of stairs, or you may have a hard time doing things you could easily do a week ago.”
In addition to affecting your quality of life, AF can increase your risk of stroke. The inefficient pumping action created by AF can cause blood to pool in the heart, which can form rather large clots. If a piece of the clot breaks off and travels to the brain, a stroke can occur. Studies show that AF quintuples the risk of stroke, and it accounts for 15 percent off all strokes that occur each year. AF also is associated with an increased risk of heart attack because of the strain placed on the heart by the erratic arrhythmia.
June 12, 2008: Attack started at 6:30 p.m. in a restaurant where
it was warm, and our hot food made it warmer. Next day, I was in AF all day.
After a year of attempting to control his AF with a “pill-in-the-pocket” approach, whereby he took the medication Flecainide at the onset of symptoms, Richard was referred to Dr. Tierney, who recommended electrical cardioversion.
The diagnosis of AF can be relatively easy. If a patient is experiencing arrhythmia at the time of testing, an electrocardiogram, or EKG, will pick up the erratic rhythm immediately. But if the AF comes and goes, the condition can be detected by having the patient wear a portable Holter monitor or event monitor to record the heart rate either continuously or at the precise moment an episode occurs. AF treatment, however, is not a one-size-fits-all matter. If the arrhythmia is caused by an underlying condition, treating the condition can cure the AF. But if that’s not the case, the goal of treatment then becomes to decrease the risk of stroke and control the symptoms so the patient can have a better quality of life, Dr. Tierney says.
The first line of defense for most patients is a variety of medications that either convert the heart rhythm to normal or slow the electrical impulse through the AV node enough to calm the heart. A procedure called electrical cardioversion where the heart is shocked back into normal sinus rhythm is an alternative for patients with more persistent AF. For more complicated cases or when other treatments
have failed, catheter ablations and surgical MAZE procedures are often successful at curing the condition.
However, for the majority of patients, non-invasive treatments and a better understanding of their triggers prove to be the best course of action. Cardioversion worked well for Richard. He had one episode of AF shortly after his procedure, but with a combination of medications and carefully monitoring the activities and conditions that could potentially trigger an attack, Richard was able to spend the next 17 months AF-free.
Richard’s triggers are some of the most commonly reported among
AF patients: stress, alcohol, dehydration and overeating. “During the warmer months, we may bike 20 or 30 miles a day,” he says. “If it’s hot out, that puts stress on your body, and that would trigger episodes for me. Alcohol too is a trigger. So if I bike 30 miles on a hot day and then have a couple of drinks, I’m almost guaranteed to have an attack. But if I’m on my game and I’m doing everything right, I don’t have them anymore.”
Steady as He Goes
January 16, 2010: We biked another 30 miles, but this time I cooled off completely before showering and laid off the alcohol, and had no problems.
Over the course of the past two years, Richard’s diary reports roughly eight episodes of AF, typically after biking or other strenuous exercise, consuming alcohol, or overeating. But now that he knows how to manage his condition, the attacks are brief and farther between. He credits Dr. Tierney, the AF websites and blogs he’s learned from, and the vitamins and minerals he takes to supplement his diet.
“What’s great is when you hear people say, ‘I’m managing my problem,’” says Richard. “Not everyone can control their condition successfully, but when you read about it, it gives you hope that you can control it and perhaps even put an end to it."
“People who have AF should have a good evaluation of their heart to check the valves and structures, and to check for previous heart attacks,” advises Dr. Tierney. “They also should have a stress test. Fifteen percent of heart attacks present during AF because of the added stress placed on the heart.”
And to prevent AF, “keep your blood pressure under control and watch your alcohol intake, especially around the holidays,” Dr. Tierney continues. “If you snore, get evaluated for sleep apnea.” All of these tactics add up to effective strategies that can help still your beating heart.