Reaching your diagnosis – Atrial fibrillation

In this Medical Monday series, we’re talking about how your doctor reaches a diagnosis of common conditions associated with coagulation. It may help if you first read the introduction, before reading about today’s topic of Atrial Fibrillation.  Altogether we’re covering

• Introduction
• DVT, Deep Vein Thrombosis
• Post-thrombotic syndrome
• PE, Pulmonary Embolism
• Pulmonary hypertension
• AF, Atrial Fibrillation
• Heart Valve conditions – aortic and mitral
• Thrombophilia
• Stroke

Introduction

Atrial fibrillation is an abnormal rhythm of the heart. It can be an intermittent (paroxysmal) or chronic condition. In this condition the upper chambers of the heart (or atria) beat erratically. This means that the blood flow  is abnormal and in part of the atria the blood becomes “static”, which allows blood clots to form and can put patients at risk of stroke.
Atrial fibrillation often occurs in people who have underlying heart disease. Almost any heart disease can increase the risk of this abnormal rhythm, but the most common causes are:

• Hypertensive heart disease due to chronic high blood pressure.
• A heart attack (myocardial infarction, or MI)
• Heart failure

Your story

Some people have no symptoms of atrial fibrillation in fact there are thousands of people with this condition who are not aware they have it. However the symptoms you might experience are unpleasant palpitations or irregularity of the heart beat, discomfort or a strange feeling in the chest or some shortness of breath. Some times these symptoms only be come apparent on exercise.

Sometimes the symptoms can be severe especially with sudden onset of the condition; these symptoms are breathlessness and fainting, or near fainting, due to a reduction in blood flow to the brain

Questions your doctor may ask

Your doctor will ask if you have had palpitations or noticed your heart racing, and will want to know if you have had chest pain. You will also be asked if you have a history of heart problems or high blood pressure and your doctor will want to know about your medication. Atrial fibrillation can be related to an over active thyroid and so your doctor will want to know if you have lost weight, noticed increased sweating or had trouble sleeping. If your heart rate is very fast you may have swollen ankles and be sightly breathless.

What your doctor may find

Your pulse will be irregular and often fast, but sometimes your pulse at your wrist is not as fast as expected. This happens when some of your heart beats are not strong enough to be felt at the wrist. Your doctor will listen to your heart to get a more accurate heart rate.

Your doctor will check your blood pressure and listen to your chest. If your heart is under strain you may have some crackles in your chest due to fluid in the lungs and may have swollen ankles.

If your doctor suspects a thyroid problem they will feel your thyroid gland in your neck and check your eyes.

Tests you may have

Tomorrow we have a post about ECGs, which is the test you will have to check the heart rhythm, this will also give the doctor more information about your heart. It can show if you have had a heart attack in the past or if there is evidence of ischaemia (poor blood flow), and your doctor can see if your heart chambers are the correct size. If your doctor heard a heart murmur or was concerned that you have more serious heart disease you may need an echo cardiogram.

You will have some blood tests to make sure you are not anaemic and to check your thyroid function. Your doctor is also likely to check your cardiac risk factors (lipids and cholesterol) and check you do not have diabetes. If there are any signs of heart failure you may have a test called the BNP as this is elevated in heart failure and can be used to monitor treatment.

What it could be

There are many causes of palpitations, these can range from minor irregular heart rate with occasional extra beats that many people notice especially when they are tired, to very serious abnormal heart rhythms. Palpitations can also occur in anxiety or panic attacks and are more common with some medication.

Fainting and breathlessness are also seen in many heart conditions.

Importance of diagnosis

Atrial fibrillation can be difficult to pick up as many people with this condition have no symptoms and it can be an intermittent problem. However anybody with atrial fibrillation, whatever the cause, has an increased risk of a stroke and they should discuss anticoagulant treatment with their doctor.

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