Atrial fibrillation

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Atrial fibrillation is an increasingly common problem. What happens in atrial fibrillation is that the pace maker of the heart ceases to function properly so that the two top chambers of the heart, namely the left and right atrium instead of contracting in an organised, rhythmical fashion simply wobble about in an uncoordinated way. I have to say, I am rather amazed that atrial fibrillation does not cause more immediate problems than it actually does! However, the heart becomes less efficient as a pump, it reduces cardiac output by about 20%, and so clinically this often manifests with poor exercise tolerance - that is to say one loses a certain level of fitness. The other complication of atrial fibrillation is that blood flow within the atria becomes rather turbulent and this can cause little clots to form on the lining of the atrium. The risk, of course, is that these little clots could break off and those going into lung could cause damage to the lung whilst those flicking off into the systemic circulation could cause small strokes or reduce blood supply to the limbs or whatever. Indeed, anybody with the diagnosis of atrial fibrillation needs a good opinion about whether or not they should be placed on anticoagulants. Obviously, anticoagulants have a risk of increasing one?s tendency to bleed so there is a fine judgement here. However, the younger one is, the more inclined cardiologists are to use anticoagulants.

It is actually not difficult to diagnose atrial fibrillation. Feel your pulse. It should be fairly regular running at between 65 and 80 beats per minute. Pulse is a little faster when you inhale and a little slower when you exhale. In atrial fibrillation the pulse is completely irregular in timing. It is also irregular in the size of the beats and with a little practice it is quite easy to distinguish between a good strong pulse and a thin thready one. In atrial fibrillation the two are mixed up as well as the rhythm being irregular. Sometimes the heart rate is very variable, but more often than not it is above 80 beats per minute.

Treatment

See Heart Dysrhythmias, Irregular Pulse, Missed beats and Palpitations

In addition, people who are in atrial fibrillation may need anticoagulants and this needs consultant opinion