Atrial fibrillation

The atrial fibrillation is the most common cardiac arrhythmia affecting about 600,000 individuals in Italy. During this arrhythmia, the atria (the two upper chambers of the heart) are activated with a very high frequency and in an uncoordinated manner, generating an irregular and often accelerated heartbeat (tachycardia). Among people over the age of 40, one in four may experience an episode of atrial fibrillation during the remaining life. Sometimes this remains the only event, while in other cases the arrhythmia tends to recur. Especially in the initial stages, the episodes tend to interrupt spontaneously, usually within a couple of days (paroxysmal atrial fibrillation); subsequently, their duration increases and interventions (cardioversion) will be necessary to determine their arrest (persistent atrial fibrillation).

When, on the other hand, attempts to interrupt and arrhythmia are no longer accepted by the doctor and the patient, the form is defined as permanent. The transformation of one form into another depends on time, on the alterations of the electrical properties of the heart (partly generated by the same arrhythmia), as well as on the presence and severity of a concomitant cardiac disease. It can treated by using Eliquis. Eliquis coupon is easily available on Prescription Hope.

What are the causes of atrial fibrillation?

In most subjects, atrial fibrillation occurs in the presence of predisposing conditions or diseases:

  • Age(the risk increases with aging, after the age of 40, one in four can present an arrhythmic episode)
  • Heart disease(previous heart attack, heart failure, valvular disease, etc.)
  • Hypertension
  • Extra cardiac diseases(pulmonary, thyroid)
  • Alcohol abuse
  • Family history(rarely)

In a small number of cases (one in ten approximately), arrhythmia occurs without an apparent cause and is therefore defined as “isolated”.

In subjects predisposed spontaneously or due to the conditions listed above, atrial fibrillation is then triggered by a series of high-frequency electrical impulses which, in most cases, originate from the muscle fibers that cover the initial part of the pulmonary veins (conduits carry blood from the lungs to the left atrium).

What are the symptoms of atrial fibrillation?

The irregular contraction of the heart, sometimes very rapid ( tachycardia ) or too slow ( bradycardia), can cause an inadequate flow of blood in the body and therefore produce symptoms felt by the patient.

The main symptoms are:

  • palpitations (feeling of accelerated and irregular heartbeat)
  • weakness or inability to perform normal physical activity
  • breathlessness
  • feeling of “empty head”
  • feeling of fainting
  • swoon

In some subjects the disorders may be very mild or even absent and the arrhythmia is occasionally discovered during a medical examination performed for other reasons. In the presence of symptomsor signs suggestive of the presence of an atrial fibrillation it is appropriate that the family doctor sends the patient to an electrophysiologist (a cardiologist who takes care of cardiac arrhythmias); in cases of greater severity, quick access to the emergency department is necessary.

What are the consequences of atrial fibrillation?

During atrial fibrillation the contraction of the atria loses enormous force and this causes a stagnation of blood which can in turn be responsible for the formation of a clot inside the chamber. Subsequently, this clot (embolus) can move from the heart and travel inside the vessels with blood until it reaches the brain (or another organ) interrupting its circulation and causing the stroke (a more or less extensive scar in the brain which causes a temporary or perennial loss of some of its functions). The risk of having a stroke it is not the same in all subjects and increases with advanced age, the presence of diabetes mellitus, arterial hypertension, reduction of the heart pump function, arterial disease or in those who have already presented a cerebral ischemia.

Another possible negative consequence of atrial fibrillation is represented by the more or less severe reduction of the pump function of the heart (heart failure). This usually occurs in predisposed subjects and especially when the frequency of contraction of the heart remains very high for a long time.

The diagnosis

The diagnosis of atrial fibrillation is generally performed through a medical examination and recording of the electrocardiogram. To complete the diagnosis further investigations could be indicated such as:

  • 24-hour dynamic ECG sec. Holter
  • Event recorder
  • Echocardiogram
  • Transesophageal echocardiogram
  • Ergometer test
  • Blood tests (especially to assess thyroid function)
  • Chest x-ray

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