The atrial fibrillation (AF) is an alteration in the heart rate (also called arrhythmia). It is the most frequent arrhythmia in our country and in the rest of the world. A healthy heart, under normal conditions, should have a regular heart rate, because the natural thing is that it accelerates only when we exercise, and that it goes slower when we sleep. The normal rhythm of the heart ranges between 60 and 100 beats per minute and is called sinus rhythm. When the arrhythmia appears, the normal rhythm of the heart changes, it can be accelerated despite being at rest (tachycardia) or slowing down (bradycardia).
AF occurs when, under normal conditions, the heart rate stops being regular and constant, the time between heartbeats and beats is uneven. This loss of synchronicity in the rhythm can cause the formation of blood clots inside the heart, since when the heart goes into fibrillation the emptying of blood from the atria may not be total. One of the best treatment is using eliquis medications. Eliquis cost is not high on Prescription Hope.
If these clots detach they can lead to blockages in the arteries of the brain (cerebral stroke) or other locations (peripheral arterial embolism). It is related to other heart diseases such as: Heart Failure, disease heart valves, etc. being able to aggravate
Depending on the duration of the episodes, it can be classified as:
Paroxysmal FA: It is of short duration (approximately 7 days), appears and disappears spontaneously.
Persistent FA: The arrhythmia does not go away on its own and lasts more than 7 days. It is necessary to take medications to control the heart rate, or to resort to techniques such as cardioversion (controlled electrical discharge) so that the heart returns to its normal rhythm.
Chronic FA: It is long lasting. The arrhythmia does not stop with medications or controlled cardioversion.
Causes of atrial fibrillation
The appearance of Atrial Fibrillation can be associated to:
- Genetic predisposition
- Arterial hypertension
- Having suffered a Myocardial Infarction
- Having had cardiac surgery
- Disease in the valves of the heart
- Congenital heart disease
- Thyroid disease
- Heart failure
- Chronic lung disease
- Sleep apnea
- Abuse of alcohol and stimulants
- Emotional and physical stress
- Lack of exercise (sedentary lifestyle)
Symptoms of atrial fibrillation
Although it does not always cause symptoms, the most common are:
- Acceleration of the heart rate and palpitations (fast and irregular heartbeat)
- Pain and pressure in the chest
- Dizziness or vertigo that may go to fainting
- Worsening of other diseases to which it is associated: Heart Failure, hypertension, diseases of the heart valves
Diagnosis of atrial fibrillation
To diagnose AF you can perform the following tests:
The only test needed to detect AF. It records the electrical activity of the heart and is a simple
and painless test. Its only drawback is that the FA has to be presented at the time the test is performed,
so when the discomfort only appear punctually, the diagnosis can be complicated.
Other tests that are done to complete the evaluation:
It is based on an electrocardiogram that records the functioning of the heart during 24 or 48 hours,
while performing the usual activities.
This allows detecting episodes of AF of short duration, or that do not provoke symptoms.
A painless scan that allows images of the heart to be obtained in order to evaluate its shape,
the state of the valves, atria and ventricles and their functioning. It also helps detect many
of the heart diseases that can cause AF.
Treatment of atrial fibrillation
Treatment depends on the severity and frequency of the symptoms and the existence or not of
associated cardiovascular disease. Its objective is to try to restore the normal rhythm of the heart (sinus rhythm):
- Cardioversion:Procedure to correct the arrhythmia and restore the normal rhythm of the heart. It can be done through antiarrhythmic drugs ( pharmacological cardioversion ) or, if they do not take effect, by electric shocks with a defibrillator ( electrical cardioversion ).
This last procedure requires general anesthesia and the taking of anticoagulant drugs before and after its application.
- Correct the situations that cause this arrhythmia and control the risk factors.
- Ablation:Technique that consists of electrically isolating the pulmonary veins (where the arrhythmia is born). To reach them, a catheter is inserted
through the groin area (femoral vein) to the heart. Once there, an electric current is generated that allows consecutive burns around
the pulmonary veins, being isolated or disconnected. It is done with local anesthesia and sedation.
- Antiarrhythmic Drugs:They are classified into two types: those that try to return the heart to its normal rhythm and those that decrease the heart rate
during episodes of arrhythmia. Its use is limited, due to its intermediate efficacy, the worsening of the arrhythmia or toxicity and its tolerability. They can have side effects: too slow heart rate, fatigue, dizziness and / or loss of consciousness.
In addition to the treatments aimed at correcting the arrhythmia, the treatment of AF includes treatments focused
on the prevention of thrombi, since AF increases between 5 and 7 times the risk of suffering a stroke or embolism.
- Anticoagulant drugs. They prevent the formation of clots and reduce the risk of thrombi forming inside the blood vessels, slowing down the blood’s clotting time. There are two types of oral anticoagulants:
- Antivitamin K (AVK). They inhibit vitamin K, a substance involved in the coagulation process. Its effect can be altered by the diet and by the interaction with other medicines, for this reason periodic controls should be carried out every 4-6 weeks and adjust the dose depending on the result of the INR. The INR is the index that indicates the time it takes blood to clot.
- Direct Oral Anticoagulants (ACODs). They directly inhibit different coagulation factors. They are administered at fixed doses, without the need for periodic controls, as their effect is predictable and constant.