Symptoms of Atrial Fibrillation

Atrial Fibrillation (A-fib) Overview

It does not always produce symptoms, but when it does, a person may experience palpitations, chest pain or discomfort, and lightheadedness.

Atrial fibrillation (AFib) is an irregular and often very rapid heart rhythm. An irregular heart rhythm is called an arrhythmia. AFib can lead to blood clots in the heart. The condition also increases the risk of stroke, heart failure and other heart-related complications.

During atrial fibrillation, the heart’s upper chambers, called the atria, beat chaotically and irregularly. They beat out of sync with the lower heart chambers, called the ventricles. For many people, AFib may have no symptoms. But AFib may cause a fast, pounding heartbeat, shortness of breath or light-headedness.

Episodes of atrial fibrillation may come and go, or they may be persistent. AFib itself usually isn’t life-threatening. But it’s a serious medical condition that needs proper treatment to prevent stroke.

Treatment for atrial fibrillation may include medicines, therapy to shock the heart back to a regular rhythm and procedures to block faulty heart signals.

A person with atrial fibrillation also may have a related heart rhythm problem called atrial flutter. The treatments for AFib and atrial flutter are similar.

What is Atrial Fibrillation?

A-fib is the most common clinical arrhythmia worldwide. Estimates suggest that it affects up to 3% of the Western population aged 20 years or older.

The risk of A-fib increases with age, but it can sometimes occur among young people.

Patients with A-fib may have a much faster heart rate than usual, and the heart does not pump blood around the body efficiently. Blood may collect, or pool, in the heart, increasing the likelihood of clots.

How does Atrial Fibrillation Affect the Heart?

The human heart consists of four chambers: two upper chambers called the atria and two lower chambers called the ventricles.

Every time the heart beats, it pumps blood from the atria into the ventricles and then from the ventricles around the body.

Each heartbeat starts at the top of the heart and travels down. Electrical signals control the rate at which the heart beats and coordinate the blood flow between the chambers.

When a person has A-fib, these electrical signals become distorted, causing the atria to quiver, or twitch, erratically. This is called fibrillation.

During the heartbeat, the heart may not pump all the blood from the atria to the ventricles, and the blood flow does not follow the usual rhythm.

Many people with an irregular heartbeat, or arrhythmia, do not have any symptoms. However, recognizing and treating A-fib early can significantly improve the likelihood of preventing complications.

Signs and Symptoms of Atrial Fibrillation

Not everyone with A-fib will have symptoms, and in those who do, the symptoms may only occur intermittently. The American Heart Association (AHA) says that the most common symptom is a fluttering heart. Other possible symptoms include:

• Breathlessness, particularly during exercise or activity
• Chest pain, pressure, or discomfort 
• Confusion or feelings of unease
• General fatigue
• Low blood pressure, dizziness, lightheadedness, and fainting
• Palpitations, or the feeling of an irregular heartbeat
• Reduced ability to exercise

Doctors advise anyone who has these symptoms,  regardless of whether they have already received an A-fib diagnosis,  to keep a record of how often they occur and note whether they become more severe.

Sharing this information with a doctor may help them recommend the best treatment.

Patients with undetected or untreated A-fib have an increased risk of heart failure and Stroke.

Some patients with atrial fibrillation (AFib) don’t notice any symptoms.

Atrial fibrillation may be:

• Occasional, also called paroxysmal atrial fibrillation.AFib symptoms come and go. The symptoms usually last for a few minutes to hours. Some people have symptoms for as long as a week. The episodes can happen repeatedly. Symptoms might go away on their own. Some people with occasional AFib need treatment.
• Persistent. The irregular heartbeat is constant. The heart rhythm does not reset on its own. If symptoms occur, medical treatment is needed to correct the heart rhythm.
• Long-standing persistent. This type of AFib is constant and lasts longer than 12 months. Medicines or a procedure are needed to correct the irregular heartbeat.
• Permanent. In this type of atrial fibrillation, the irregular heart rhythm can’t be reset. Medicines are needed to control the heart rate and to prevent blood clots.

Causes of Atrial Fibrillation

Changes in the electrical signals in the heart cause A-fib. It can happen to anyone at any age, but it is more common among older people. Other risk factors include:

• Alcohol consumption: Although regularly consuming large amounts of alcohol puts people at the highest risk, even modest amounts can be a trigger for some individuals. Other toxic drugs, such as methamphetamine, can also cause A-fib. 
• A problem with the heart’s natural pacemaker, called sick sinus syndrome.
• Family members with A-fib: People with a family history of A-fib may be more likely to experience the condition themselves.
• Heart disease: Patients with underlying heart conditions have a higher risk of A-fib. These conditions include heart valve disease, heart failure, coronary artery disease and heart attack.
• Hypertension: Long-term high blood pressure can place strain on the heart. 
• Infections from viruses.
• Narrowed or blocked arteries: This is called coronary artery disease.
• Sleep apnea: This can increase a person’s risk of A-fib, particularly when it is severe. 
• Thyroid disease such as an overactive thyroid.
• Other chronic conditions: Some long-term medical conditions, including thyroid problems, asthma, diabetes, and obesity, may add to the risk. 
• Lung diseases, including pneumonia
  
• Pulmonary embolism: This is the medical term for a blood clot in the artery that delivers blood to the lung.

Treatment of Atrial Fibrillation

Doctors tailor the treatments for A-fib so that they are suitable for the person’s age and lifestyle, heart health, and overall health. Some people may only need medications, while others may need surgical procedures to stabilize their heart rhythm. Sometimes, doctors recommend a combination of treatments.

Medications

Prescription medicines can control a person’s heart rate, prevent clots from forming, and, for some patients, normalize heart rhythm.

Managing Heart Rate

If a person’s heart rate is high, bringing it down will prevent heart failure and potentially reduce the symptoms of A-fib.

Several medications can help by slowing signals that tell the heart to beat. These include:

• Beta blockers such as metroprolol (Lopressor) and atenolol (Tenormin)
• Calcium channel blockers , such as diltiazem (Cardizem) and verapamil (Verelan)
• Digoxin (Lanoxin), which doctors now use more rarely

Preventing Blood Clots

A doctor may prescribe anticoagulant medications, or blood thinners . These medications make it harder for blood to clot.

Taking blood-thinning medications can increase a person’s risk of bleeding. However, for most people, the benefits of preventing blood clots outweigh the risks of bleeding, particularly if the person is at risk of stroke.

Doctors use the  CHA2DS2-VASc score to evaluate the risk of stroke and establish whether a person is likely to benefit from taking blood thinners.

Some blood-thinning medications include direct-acting oral anticoagulants, such as apixaban (Eliquis), rivaroxaban (Xarello), edoxaban (Lixiana), and dabigartan (pradaxa),  and, less commonly, warfarin.

Anyone taking warfarin or another anti-clotting agent should make sure that any medical professionals who are treating them are aware of this medication. This is especially important during the treatment of other conditions and before surgeries.

Normalizing Heart Rhythm

Doctors may try to return the heart rhythm to normal using medication. This is called chemical, or pharmacological, cardioversion.

These so-called anti-arrhythmic medications can help convert A-fib into a regular heart rhythm or maintain a regular rhythm.

They include sodium channel blockers, such as flecainide (Tambocor), and potassium channel blockers, such as amiodarone (Pacerone).

However, even after the heart rhythm returns to normal, most people need to take blood-thinning medications.

Procedures

Doctors sometimes recommend surgical procedures alongside medication, particularly if the person is due to have heart surgery for another health condition. The options for surgery may include the following:

• • Electrical cardioversion: A surgeon will deliver a synchronized electric shock to the heart. This can reset the irregular rhythm to a regular beat. Before carrying out cardioversion, they may perform a transesophageal echocardiogram. 
  • Catheter ablation: This destroys the tissue that is causing the irregular rhythm. The surgeon may need to repeat this procedure if A-fib returns.
  • Surgical ablation: Surgeons can also remove the heart tissue causing the irregular rhythm by carrying out a form of open-heart surgery called a maze procedure.
  • Pacemaker placement: This device instructs the heart to beat regularly. 

Complications of Atrial Fibrillation

According to the AHA, for most people with A-fib, the most serious risk is that it can lead to other, life threatening conditions. These include:

Blood Clots

Blood can pool in the atria if the heart is not beating regularly. Blood clots can then form in these pools.

A segment of a clot, called an embolus, might break off and travel to different parts of the body through the bloodstream and cause blockages. For example, an embolus can restrict blood flow to the kidneys, intestine, spleen, brain, or lungs. A blood clot can be fatal.

Stroke

A stroke occurs when a blood clot blocks an artery in the brain, reducing or stopping blood flow to part of the brain.

The symptoms of a stroke vary depending on the part of the brain in which the stroke occurs. They can include weakness on one side of the body, vision problems, and speech and movement difficulties.

Stroke is a leading cause of disability and death in the United States.

Heart Failure

A-fib can lead to heart failure, especially when the heart rate is high. When the heart rate is irregular, the volume of blood flowing between the heart’s upper and lower chambers varies for each heartbeat. The heart muscle can tire out from beating too quickly and irregularly.

As a result, the heart may not pump enough blood to the body, and the amount of blood waiting to circulate can instead build up in the lungs and other areas.

Cognitive Problems

A 2018 study linked A-fib with a higher long-term risk of cognitive decline and dementia. However, other research from 2019 questions this, saying that the link is unclear. More research is necessary to clarify this.

Reducing the Risk of Atrial Fibrillation

Although aging and a family history of A-fib are nonmodifiable risk factors, there are many ways to reduce the risk of A-fib and maintain a healthy heart. In 2020, the AHA published a scientific statement saying that lifestyle changes can reduce many of the risks.

Keeping any underlying conditions, such as hypertension or diabetes, under control also reduces the risk of A-fib. The AHA statement and other studies stress the importance of multidisciplinary medical treatment plans.

When it comes to lifestyle, the basic rules of following a nutritious diet, engaging in regular physical activity, and maintaining a moderate body weight are important. People who smoke or drink alcohol can also reduce their risk of developing A-fib by limiting or stopping these behaviors.

Atrial Fibrillation Frequently Asked Questions

Following section answers some common questions about atrial fibrillation.

How do I Stop Worrying about A-Fib?

It is normal for a person to experience a range of emotions when they are diagnosed with atrial fibrillation (A-fib), including fear, anxiety, and low mood.

To ease feelings of worry, a person might find it helpful to learn more about their condition and lean on their support network.

Research has shown that people who have a good understanding of their A-fib report fewer symptoms, feel more in control of their condition, and feel less distressed by it.

Is A-Fib a Serious Heart Condition?

Atrial fibrillation (A-fib) is not life threatening, but it is considered serious as it increases the likelihood of a person developing blood clots, which can block the blood supply to other organs.

Does A-fib Go Away on its Own?

Sometimes, atrial fibrillation (A-fib) goes away on its own. For others, it’s an ongoing heart problem that lasts for years.

With the latter, a person will need regular medications or treatment to manage their heart rate and prevent blood clots.

Does AFib Cause Heart Attacks?

Having atrial fibrillation (A-fib) can put a person at an increased risk for stroke and heart attack.

What Does Atrial Fibrillation Feel Like?

Many people with A-fib experience a rapid heartbeat, which can make it feel as though the heart is missing a beat or pounding in their chest. Other people may feel dizzy, faint, or inexplicably anxious.

Patients with A-fib may have difficulty breathing, particularly when lying down.

Most individuals will have these feelings from time to time, but anyone who notices them happening more regularly, or more intensely, may have A-fib.

Prevention of Atrial Fibrillation

Healthy lifestyle choices can reduce the risk of heart disease and may prevent atrial fibrillation (AFib). Here are some basic heart-healthy tips:

• Control high blood pressure, high cholesterol and diabetes.
• Don’t smoke or use tobacco.
• Eat a diet that’s low in salt and saturated fat.
• Exercise at least 30 minutes a day on most days of the week unless your health care team says not to.
• Get good sleep. Adults should aim for 7 to 9 hours daily.
• Maintain a healthy weight.
• Reduce and manage stress.

Atrial Fibrillation Summary

A-fib is a condition that causes an irregular heart rhythm. It occurs more often after the age of 65 years, and it may not always cause symptoms. The condition can lead to a stroke if blood pools in the heart and forms a clot that travels to the brain.

Lifestyle adjustments can help prevent A-fib. These include prioritizing a heart-healthy diet, limiting alcohol intake, avoiding smoking, maintaining a moderate weight, and getting regular exercise.

Treatment will focus on normalizing the heart rhythm and preventing complications. A doctor may prescribe medications that regulate heart activity and blood-thinning drugs to prevent clots. In certain circumstances, they may recommend surgical procedures.

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