Atrial fibrillation can lead to stroke

Atrial fibrillation is an abnormal heart rhythm. While it primarily affects people over 65 years old, it can be seen in all age groups, says Dr. Monica Aggarwal, a cardiologist from the Heart Center at Mercy Medical Center.

•Atrial fibrillation is a rhythm that is faster and more erratic than our normal heart rhythm. It causes decreased blood flow to the rest of the body and leads to blood pooling in the heart, which can lead to clot formation. Smaller clots can break off this thrombus, travel to the brain and cause a stroke.

•Heart disease - as in high blood pressure, heart attack, heart failure and heart valve disease - can increase the risk of atrial fibrillation. Common non-cardiac causes are hyperthyroidism, binge alcohol drinking (often known as the "holiday heart"), chronic lung disease, and certain medications. We often see this rhythm after surgeries when people's bodies are in overdrive. An often under-appreciated cause of atrial fibrillation is sleep apnea.

•People will often describe a heart-racing sensation or palpitations. Some people will feel chest pain, shortness of breath or generalized fatigue. Others will feel lightheaded. It is also possible to have no symptoms at all.

•Diagnosis is made with an EKG or heart monitor. Further studies may include an ultrasound, an echocardiogram (to check heart strength), blood tests and possibly a stress test.

•During treatment, a patient's heart rate is often slowed to allow the heart to fill and get blood to the rest of the body. Often, doctors will try to get their patients out of atrial fibrillation with medications or electrical shock, known as cardioversion. If electrical cardioversion is needed, people are sedated so they do not feel the shock. Maintenance medications may be prescribed to keep patients in normal rhythm. For those with recurrent episodes of atrial fibrillation, more invasive options are available.

•The risks of atrial fibrillation are symptoms, excess demand on the heart with faster heart rates, dilation of the heart and increased risk of stroke because of the blood pooling described above. Therefore, patients with a history of atrial fibrillation are often candidates for blood thinners. Blood thinners range from aspirin to warfarin, with warfarin being the far superior medication for prevention of blood clots. Each person, however, is considered individually. The risks of bleeding because of blood thinner use are weighted against the risk of stroke without blood thinner use. Stroke rate increases with age, other cardiac conditions such as high blood pressure and heart failure, diabetes, and among those who have previously had strokes.