Thursday June 8, 2017
Continuing with London Doctors Clinic's Heart Health Week, today we're focusing on the abnormalities of the heart's rhythm. These abnormalities can be picked up by our highly experienced private doctors in clinic, by feeling you pulse, listening to your heart with a stethoscope, or better still, performing an ECG.
Today we're talking about one of the most common causes of an irregular heart beat: Atrial Fibrillation.
How The Heart Beats
Beating more than 2.5 billion times during your lifetime, your heart certainly could win a Grammy nomination for longest drum solo. But what happens when the rhythm falls out of time?
Your heart's rhythm is controlled by a special cluster of cells called the sinus node, which sit at the top of the atria (the two upper chambers of the heart). These cells are known as the heart's "natural pacemaker" - a built-in orchestra leader that conducts via tiny electrical signals, which travel through the heart muscle to enable the atria to contract and push blood into the ventricles (the two lower chambers of the heart) in a co-ordinated way. Sounds complex, doesn't it?
In atrial fibrillation (or AF), additional electrical signals are fired within the atria, which can cause the heart’s orchestra to become disorganised. Instead of contracting together, the atria contract rapidly and irregularly, or “fibrillate”, producing a disturbance in heart rhythm known as an arrhythmia.
It is easier to understand AF by likening the heart to an orchestra, with the sinus node taking the role as conductor
Who is Affected By Atrial Fibrillation?
AF is the most common arrhythmia, affecting over one million people in the UK. Although it can happen at any age, it becomes more common as you get older. AF is also more common in heart conditions such as:
- High blood pressure
- Heart valve disease
- Coronary artery disease
- Cardiomyopathies (diseases of heart muscle)
And can be triggered by other conditions, including:
- Hyperthyroidism (An overactive thyroid gland)
- Excessive alcohol or caffeine consumption
About 1 in 10 cases, however, occur in completely normal hearts!
What Are The Symptoms of Atrial Fibrillation?
AF can cause your heartbeat to feel:
- Faster than normal - greater than 100 beats per minute
- Irregular - the feeling of “pounding” or “fluttering”, known as palpitations
As the atria are contracting faster, this causes the heart to be less efficient at pumping blood around the body. This can cause symptoms of:
- Dizziness/ lightheadedness
- Chest pain (known as angina)
You should always book a GP appointment if you experience a sudden change in your heartbeat, a heart rate consistently lower than 60 or greater than 100 beats per minute, or chest pain.
That said, some people may have no symptoms, and are diagnosed by chance when a doctor feels their pulse – which is why the Heart Rhythm Alliance is running it's Heart Rhythm Week, to raise awareness of arrhythmias. The British Heart Foundation has a great guide for checking your pulse.
Describing Atrial Fibrillation
There are a number of different types of AF, depending on how the episodes affect you.
- Paroxysmal – episodes where the heart returns to natural rhythm by itself, usually within 48 hours
- Persistent – episodes longer than seven days, unless treated
- Permanent – episodes longer than a year
What Tests Do I Need To Have?
If your GP suspects you may have AF, this can be confirmed using an electrocardiogram (ECG), a tracing of the rhythm of your heart using electrodes applied to the skin. This can be done in real time (such as during your private GP appointment at LDC!), or worn over 24 hours at home. Other tests, such as an echocardiogram (an ultrasound scan of the heart), may also be used to give a moving image of how the heart is working.
Treating Atrial Fibrillation
AF isn’t usually life threatening, but can definitely feel uncomfortable! However, there are a variety of treatment options to help restore the heart’s orchestra to its natural rhythm.
For some people with newly diagnosed AF, the heart’s rhythm can be 'reset' using either a controlled electrical signal (electrical cardioversion) or an anti-arrhythmic drug in hospital, which 'convert' disorganised signals back into regular rhythm.
For AF episodes that last longer, medications can be used to reduce the frequency and/or severity of episodes. These include:
- Beta Blockers – such as sotalol, which reduce the rate at which the heart contracts
- Anti-Arrhythmics – such as flecainide or amiodarone, which control the disorganised electrical signals.
3. Catheter Ablation
In a small number of patients, if medication fails to work or causes side effects, a small flexible tube can be passed into the heart in hospital to destroy the area of the heart that causes the abnormal rhythm.
Reducing The Complications of Atrial Fibrillation
Although AF is common and well-managed, it is important to be aware of the increased risk of stroke in untreated AF, due to blood clot formation in the heart. Your doctor will assess the need for medication to reduce this risk, which may include anticoagulants such as warfarin, which lengthen the time blood takes to form clots (reducing the risk of stroke by 50 to 70 percent) or anti-platelets such as aspirin, which prevent platelets from sticking together to form a clot.
There are also many modifiable factors that can contribute towards stroke risk – meaning they can be changed, whether you have AF or not (a win-win!). These include smoking, high blood pressure, being overweight, high cholesterol and diabetes. You can find more information on all of these in on our website, especially our blog!
To avoid complications of atrial fibrillation, try to quit smoking!
So, if you've ever experienced any of the above symptoms, or have any concerns regarding your heart health, you know where to find us! We've got nine central London clinics (some of which are open seven days a week), with short-notice and same-day doctor appointments available throughout. It's better to be safe than sorry, if you have any concerns about your heart health.
By Ellice Caldwell-Dunn