In an earlier article, we discussed hypertension and the role of pharmacies in performing blood pressure checks. Following on from the NHS blood pressure checks service is atrial fibrillation detection. Here, we look at what atrial fibrillation is, some of the common symptoms, its causes and when a patient needs to see a GP for further tests.
What Is Atrial Fibrillation?
Atrial fibrillation (A-fib) is an irregular and often rapid heart rhythm that can induce blood clots in the heart. In some cases, it is considerably higher than 100 beats per minute and can raise the risk of stroke, heart failure as well as other cardiac problems. When this happens, you may feel an irregular and often faster heartbeat or pulse.
Some say it feels like their heart is racing, which is also known as heart palpitations. When atrial fibrillation comes and goes, it is referred to as paroxysmal atrial fibrillation but sometimes it doesn’t go away at all. While it’s not a life-threatening condition, it is considered serious since it could create blood clots that may raise the risk of a stroke.
What Causes A-Fib?
As it stands, the cause of atrial fibrillation remains unknown but it is more common with age and can affect certain people more than others. It is often linked to damage to the heart with the following conditions making the top of the list:
- high blood pressure (hypertension)
- myocardial infraction
- heart valve disease
- congenital heart disease
- cardiomyopathy
- pericarditis
Atrial fibrillation is also associated with other medical conditions, including lung cancer, type 2 diabetes, pneumonia, overactive thyroid, asthma, carbon monoxide poisoning and pulmonary embolism.
It’s important to note that not everyone with atrial fibrillation suffers from one of these conditions. The truth is, it sometimes affects people who are physically fit, even athletes, and is known as lone atrial fibrillation.
Common Symptoms Of Atrial Fibrillation
Atrial fibrillation is the most common heart rhythm disturbance and affects approximately 1.4 million people in the UK. It can impact adults of any age but it is more common in older people and interestingly, more men than women.
Among the first signs of atrial fibrillation are noticeable heart palpitations where it feels like your heart is pounding, fluttering or beating irregularly. While it often only lasts for a few seconds, in some cases it could be several minutes or hours. Other symptoms of atrial fibrillation include the following:
- chest discomfort or pain
- finding it harder to exercise
- tiredness
- shortness of breath
- dizziness or feeling faint
How To Diagnose Atrial Fibrillation
Considering A-fib doesn’t always cause obvious symptoms, some people are unaware of their irregular heart rate. The good news is that pharmacists can detect atrial fibrillation during a routine blood pressure check by identifying an irregular pulse and if that is the case, they will refer the patient to a GP surgery for further tests, including the following:
- ECG (electrocardiogram)
- Echocardiogram
- Chest x-ray
- Blood tests
Treatment For Atrial Fibrillation
Since A-fib increases the risk of a blood clot forming in the brain, the likelihood of a stroke is a real risk factor. However, with the right treatment options, you can reduce your risk considerably. For over 50 years, the drug of choice to prevent AF-related strokes has been warfarin but it requires frequent blood tests and careful monitoring.
If a patient presents with symptoms of AF, doctors will find a treatment plan to control the rate and rhythm of your heart. This may include medication such as beta-blockers and anti-arrhythmic drugs, ablation, cardioversion and even a pacemaker. However, thanks to a new type of Direct Acting anticoagulants (DOAC), healthcare professionals have more options at their disposal.
What Are Direct Acting Anticoagulants?
The Direct Acting Anticoagulants (DOACs) are a class of drugs that may be used to help prevent strokes for people with non-valvular AF. This is when atrial fibrillation is not associated with a heart valve issue. DOACs can also be used to manage venous thromboembolism, which is when a blood clot forms in a vein.
In the UK, most people have non-valvular atrial fibrillation and, like warfarin, these Direct Acting anticoagulants can help to prevent clots from forming while helping to protect you from certain types of strokes. Several drug manufacturers have been involved in developing DOACs with the most common brands in the UK including:
- Rivaroxaban (brand names include Xarelto)
- Dabigatran (brand names include Pradaxa)
- Apixaban (brand names include Eliquis)
- Edoxaban (brand names include Lixiana)
How Do Direct Acting Anticoagulants Work?
Atrial fibrillation increases the risk of stroke since blood can pool in the heart and increase the risk of clots forming. If these clots pass through the heart, they can easily block a blood vessel in the brain which can lead to a stroke. To minimise the risk, anticoagulants make the blood take longer to clot.
All of the DOACs have been proven as effective at preventing strokes as warfarin. The main difference, however, is that DOACs aren’t influenced nearly as much as warfarin in terms of diet and other medications. This means a GP can prescribe a dose of a DOAC knowing the patient is protected as long as they keep taking the drug.
Tips For Reducing The Risk Of A Stroke
While anticoagulants are the most effective treatment to reduce the risk of stroke in people with AF, a healthy lifestyle can also really help. Here are a few simple changes you can make:
- Follow a healthier eating plan by swapping to lower fat options and leaner meats
- Get more active by taking a brisk half-hour walk every day and taking the stairs when you can
- Quit smoking and cut down on alcohol consumption
- Control high blood pressure by cutting down on salt and employing good stress management techniques
- Lower your cholesterol levels by eating more fibre and swapping saturated fats (butter, takeaway meals) for unsaturated fats (olive oil, oily fish)
- Watch your blood sugar levels, especially if you have diabetes. Try swapping sugary snacks for fruits and choose sugar-free drinks
Recommended: How To Recognise The Signs Of A Stroke
When To Consult Your GP
While there is a bigger focus on self-care in the UK, you don’t mess about with atrial fibrillation as it can be dangerous. If you have chest pain, that comes and goes, you have chest pain that goes away quickly but you are still worried or if your heart rate is consistently lower than 60 or above 100, book an appointment to see your GP. It’s even more important to do this if you are experiencing other symptoms of atrial fibrillation, such as dizziness and shortness of breath.
In more serious cases when experiencing the following chest problems, you need to call 999 since you may be having a heart attack and urgent medical treatment is required.
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