Dr. M.J. Bazos, MD Patient Handout


About Your Diagnosis

Fibrillation is a type of abnormal contraction in a muscle. In the heart the atria and ventricles must squeeze in a coordinated way to move the blood effectively. A fibrillating muscle looks as if it is wiggling rather than squeezing and does not move blood the way a normal contraction does. If this occurs in the atrium, the blood inside is not pumped into the ventricle normally and tends to pool. The ventricles can pull most of the blood in and contract to push it out, which allows the heart to perform most of its function. Pooling of blood and inefficient movement of blood through the atrium may cause other problems. If the pooled blood clots, the clots can be sent into the bloodstream and can cause heart attacks or strokes. When the atrium is fibrillating, it is attempting to contract (but the contractions are small) and may signal the ventricle to contract. Because the fibrillation is irregular and fast (wiggling), the contractions are irregular and fast. The ventricles contract when signaled and beat fast. This abnormal rhythm of the heartbeat is arrhythmia. Because the ventricles are not filling with blood normally, they must work harder to supply blood to the body and may eventually go into heart failure.
Living With Your Diagnosis
Many things can cause atrial fibrillation. Many persons have atrial fibrillation and never feel it. The most common cause is aging, because the heart becomes more susceptible to changes. Heart and lung disease, other illnesses, and stress also can cause atrial fibrillation. Caffeine, nicotine (cigarettes), and excess alcohol can cause it or make it worse. Symptoms of atrial fibrillation are commonly the feeling that the heart is beating irregularly or too fast (palpitations). Symptoms of heart failure such as difficulty breathing, chest pain, or fainting may occur. Some persons feel fatigued or have difficulty with exercise. If there has been fibrillation for some time and clots have formed, chest pain or signs of stroke are dangerous and must be evaluated immediately. Atrial fibrillation is diagnosed on the basis of a particular pattern of pulses and tracings on an electrocardiogram (ECG). The physician may check the motion of the atrium with an echocardiogram (ultrasound examination of the heart). This examination can show whether there are clots in the atrium.
Management of atrial fibrillation focuses on the underlying cause. For example, if there is thyroid disease, the patient is treated for this condition. If the fibrillation is caused by too much caffeine, reduction of caffeine intake is recommended. While the cause is being sought or being treated, relief of symptoms depends on what the patient experiences or feels. Heart disease, for example, can be managed, but the fibrillation may not revert to normal. Fibrillation can be managed with digitalis (digoxin) to help control the rate at which the ventricles contract. It also makes ventricular contractions more efficient. Digoxin therapy often is started in the hospital so that the level of drug in the body and changes in heart rhythm can be monitored. If digoxin therapy continues outside the hospital, the level of the drug in the blood has to be measured periodically. If clots have formed in the atrium, anticoagulants such as warfarin (eg, Coumadin) may be prescribed. This drug can cause easy bruising or bleeding, and
levels are checked periodically. Arrhythmia may be managed with an antiarrhythmic drug such as verapamil or propranolol. This drug also may lower the blood pressure and cause headaches, dizziness, or nausea. The abnormal rhythm of the heart from atrial fibrillation sometimes has to be electrically shocked back to normal. This procedure is called cardioversion. If you are taking medicine to manage thyroid, heart, or lung disease, for example, the drugs should be taken as directed to avoid more fibrillation.
The DOs
•Stop smoking.
•Reduce your intake of alcohol or caffeine.
•Eat a diet that is healthful for your heart. Decrease fat and cholesterol.
•Lose weight.
•Minimize your stress as much as possible, because stress can worsen you.
•Exercise to your level of tolerance if you are taking the proper medications and have no symptoms.
•Take your medicines as prescribed, and have drug blood levels monitored.
The DON’Ts
•Avoid activities that cause bruising if you are taking anticoagulants.
When to Call Your Doctor
•If you have side effects from your medications or if you have new or worsening symptoms. This includes chest pain, shortness of breath or difficulty breathing, fainting, palpitations, or sudden changes in the ability to speak, eat, walk, or use your limbs.
•If you are taking anticoagulants and sustain a serious cut or head injury.