The television ads for the Kardia instrument that can detect atrial fibrillation of the heart ask – “do you have atrial fibrillation?” The answer from the majority of people questioned is, “What is that?” or “I don’t know.” Yet, this medical condition is very common and increases in incidence with age and, when it occurs and is not detected and treated, the risk of stroke rises significantly. Accordingly, seniors in particular should be aware of the condition, the possible symptoms and the ways in which it can be diagnosed and treated.
The heart consists of four chambers – the upper chambers called the atria and the lower chambers called the ventricles. Normally, the electrical impulses to the atria are regular but in atrial fibrillation (Afib), the signals are irregular and send irregular signals on to the major pumps, the ventricles, resulting in an irregular pulse. Trained medical practitioners and electrocardiogram instruments can confirm the diagnosis. Symptoms may include a faster and irregular pulse, palpitations in the chest or chest discomfort, but many people will experience no symptoms at all. At the annual snowbird meetings when visitors at the booth had their blood pressure taken, my wife – an RN – and I would sometimes detect what we suspected was an irregular pulse associated with Afib even though the individual had no symptoms at all. We would advise the person to seek further assessment.
Snowbirds must be aware of the need for immediate attention if they become aware of suspected heart symptoms such as those of Afib. Contact should be made with your insurance assistance personnel who can direct you to appropriate care. An urgent doctor’s appointment or a walk-in clinic would allow for an immediate detection of Afib and initiation of treatment. If neither was available, an emergency room visit would be warranted.
When we all had a family doctor and the annual health examination was fairly routine, Afib was often discovered in asymptomatic patients. Today, such full examinations are not usually the case, and many people have no primary care doctor at all. Because atrial fibrillation is often associated with no symptoms, it becomes imperative to seek other ways to detect the condition. A nurse, a doctor or a paramedic can easily confirm an irregular pulse leading to a suspicion of possible atrial fib.
A small number of affordable, personal-use ECG monitors are currently on the market, including the Kardia monitor which sells in Canada for about $100.00. The battery-powered instrument connects to your smartphone and displays your heart rhythm and rate. It can detect possible Afib and prompt you to seek medical attention. The recordings can be sent to your own doctor or, for a low monthly fee, can be monitored by the company’s cardiology staff. Some smartphones and electronic blood pressure cuffs may indicate an irregular pulse, but they cannot differentiate harmless irregularities from Afib. A review of ECG monitors can be found at https://www.healthline.com/health/ecg-monitor – 1
People who have previously been treated for Afib find these personal-use ECG monitors especially helpful in their ongoing care. Because some people have recurrent Afib, even after various treatments, they are more easily able to self-monitor their heart rhythm and detect recurrence of the irregular heartbeat. Even people who have intermittent episodes of Afib are at risk for stroke, so early detection becomes important. For people who are healthy and have no cardiac history, risk factors or symptoms, such personal-use ECG monitors are probably not cost-effective, but for anyone with a history of cardiac issues or for those who may from time to time experience symptoms, especially palpitations, this initial screening tool is a worthwhile purchase.
Once Afib has been confirmed with either an office or hospital ECG machine, a treatment plan is developed for the patient. If the ECG does not detect Afib and there is still suggestion of episodes of abnormal pulse or symptoms, a 24-hour monitoring device called a Holter monitor can be worn by the patient to further detect any periods of abnormal heart function.
The objective of treatment is to return the heart to a regular beat, reduce any fast pulse rate and prevent blood clots from forming in the heart. If the pulse rate is rapid, certain drugs called beta-blockers or calcium channel-blockers are most commonly prescribed. To help control the rhythm and pulse rate, other drugs including digoxin may be used. Blood thinners are prescribed whose aim is to reduce the risk of clots developing in the heart which, if released, can travel to the brain and cause a stroke. Warfarin, the original blood thinner, requires regular blood tests to monitor the proper dosage but the newer anticoagulants do not. Snowbirds who are required to take Warfarin should request a written order for the routine test by their Canadian doctor and then find a laboratory near their winter destination which will accept the doctor’s order. The results would be sent to their Canadian doctor to see if any change in dosage was warranted. This process works for most and saves the patient the costs associated with these non-emergency doctors’ fees while away.
Patients who are newly diagnosed with Afib may be offered a procedure called cardioversion, in which an electrical shock is applied externally to the chest wall. Another initial attempt to reset the heart rhythm may be tried through oral or intravenous medication. As either an initial treatment or a planned procedure, cardiac ablation is often utilized. This procedure involves inserting a catheter into a large vein and extending it to the heart to administer cold, heat or electrical energy creating tiny scars to block the faulty electrical signals that cause the irregular heartbeat.
Afib can occur with anyone but, as with many other conditions, the risk is reduced in those who follow a healthy lifestyle. A healthy diet, avoiding excess weight, getting regular exercise, keeping blood pressure and lipid levels within normal ranges, as well as avoiding smoking and excessive alcohol are all important measures that help to keep you and your heart healthy.