16765 Atrial Fibrillation Afib

Overview

Atrial fibrillation, often called AFib, is a heart condition that causes an irregular and often unusually fast heartbeat. Normally, your heart beats in a steady rhythm, but in AFib, the upper chambers of the heart (the atria) quiver or 'fibrillate' instead of squeezing properly. This can make blood pool and clot, raising the risk of stroke, and can also make your heart work less efficiently.

Yes, AFib is common. Millions of people around the world live with it, and the number is growing as populations age. Many people with AFib do not even know they have it because symptoms can be mild or absent.

AFib becomes more common with age, especially after 60. It also affects people with high blood pressure, heart disease, obesity, diabetes, or a history of alcohol overuse. Men are somewhat more likely than women to develop AFib, but women with AFib tend to have more symptoms and a higher stroke risk.

Symptoms

Common symptoms

• A fluttering or racing feeling in the chest (palpitations)
• Irregular pulse that feels 'all over the place'
• Feeling tired or weak
• Shortness of breath, especially with activity
• Dizziness or light-headedness
• Chest discomfort, pressure, or pain

Symptoms in children

• AFib is rare in children, but if it happens, symptoms may include a rapid heartbeat, fatigue, poor feeding (in babies), and trouble keeping up with play or sports.
• Sometimes children with congenital heart disease (heart problems present at birth) are more likely to get AFib.
• Children may not be able to describe palpitations; they might just seem unusually tired or irritable.

Symptoms in older adults

• Older adults may feel less obvious symptoms, like just mild tiredness or a slight breathlessness.
• Some older adults with AFib feel dizzy or faint, and this can increase the risk of falls.
• Sometimes the first sign of AFib in an older person is confusion or feeling 'off' without a clear chest symptom.
• They may also have no symptoms at all, and AFib is only found during a routine check-up.

Causes

Main causes

• High blood pressure (hypertension)
• Coronary artery disease or a previous heart attack
• Heart valve problems
• An overactive thyroid gland (hyperthyroidism)
• Excessive alcohol use, especially binge drinking
• Heavy caffeine or stimulant use
• Sleep apnea (interrupted breathing during sleep)
• Stress, severe illness, or major surgery

Risk factors

• Age over 60
• Obesity
• Diabetes
• Family history of AFib
• Chronic lung disease, such as COPD
• Long-term endurance training in some people
• Previous heart surgery

When to see a doctor

See a doctor urgently if:

• If you have chest pain, fainting, or symptoms of a stroke, call your local emergency number immediately.
• If your heart is racing and you feel dizzy or very short of breath, seek same-day medical care.

Book a routine appointment if:

• If you notice an irregular pulse or a fluttering feeling that comes and goes, make an appointment with your doctor.
• If you feel unusually tired or short of breath during normal activities, bring this up at your next visit.
• If you have high blood pressure or diabetes, ask your doctor about AFib screening during routine check-ups.

Diagnosis

To diagnose AFib, your doctor will listen to your heart, check your pulse, and ask about your symptoms and medical history. The most common test is an electrocardiogram (ECG or EKG), which records your heart's electrical activity. If your AFib is intermittent, your doctor might ask you to wear a portable heart monitor for a few days or longer to catch the irregular rhythm.

Tests that may be done

• Electrocardiogram (ECG): a quick, painless test that measures the electrical signals of your heart
• Holter monitor or event recorder: a small wearable device that records your heart rhythm over time
• Blood tests: to check for thyroid problems, electrolyte imbalances, or other conditions that can trigger AFib
• Echocardiogram: an ultrasound that shows the structure and pumping function of your heart, and checks for clot risk
• Stress test: records your heart's response to exercise, if needed

What to expect at your appointment

Your doctor will explain what AFib means for your health and discuss steps to reduce the risk of stroke. You may be referred to a heart specialist (cardiologist) for further tests or management. The diagnosis process is generally not painful, and many people leave the first appointment with a clear plan of action.

Treatment

Treatment for AFib aims to control your heart rate, restore a normal rhythm when possible, and prevent blood clots that can cause strokes. Your doctor will personalize your treatment based on your symptoms, age, overall health, and the cause of your AFib. Some people only need lifestyle changes and regular monitoring, while others may need medicines or a procedure.

Self-care at home

• Learn to take your pulse and know what your target heart rate range is (ask your doctor)
• Limit or avoid alcohol, especially heavy intake
• Cut back on caffeine if it triggers palpitations
• Quit smoking and avoid secondhand smoke
• Keep regular follow-up appointments so your doctor can check your heart rhythm
• Track your symptoms in a simple diary to share with your doctor

Medical treatments

Medicines are often used to slow a fast heartbeat (rate-control medicines), to help the heart beat more steadily (rhythm-control medicines), or to thin the blood (anticoagulants) to prevent blood clots and stroke. Your doctor will choose the right type and dose for you. Always take medicines exactly as prescribed and never stop without talking to your doctor. Regular blood tests may be needed to monitor some of these medicines.

When is surgery considered?

If medicines do not control AFib well, or if you cannot tolerate them, a doctor may suggest a procedure called catheter ablation. In this treatment, a thin tube (catheter) is guided to the heart to carefully destroy tiny areas of tissue that are causing the faulty electrical signals. Another option is a direct-current shock (cardioversion) to reset the heart's rhythm. These are done in a hospital by heart specialists.

Living with this condition

Living with AFib is different for everyone. You can often keep doing most of your usual activities, but you may need to pace yourself on tired days. Keep a pulse oximeter or blood pressure monitor at home if your doctor recommends it. Learn to notice the warning signs that your heart rhythm is off, and know when to call for help.

Lifestyle tips

• Aim for 7 to 8 hours of restful sleep each night; untreated sleep apnea can worsen AFib
• Try to keep your weight in a healthy range, as obesity puts extra strain on the heart
• Practice stress reduction with deep breathing, meditation, or talking to a friend/counsellor
• Stay hydrated but avoid large amounts of caffeinated or sugary drinks
• Keep alcohol intake low – even one or two drinks can trigger episodes in some people
• If you smoke, seek support to quit; smoking significantly increases stroke risk

Diet and exercise

Eat a heart-healthy diet rich in vegetables, fruits, whole grains, lean protein, and healthy fats like olive oil. Limit processed foods, salt, and added sugars. Regular physical activity is safe and beneficial for most people with AFib. Walking, swimming, or cycling are good options. Talk to your doctor before starting a new exercise program, and listen to your body – rest if you feel dizzy or very tired.

Mental health and emotional wellbeing

Feeling anxious, stressed, or low after an AFib diagnosis is normal. The unpredictability of heart rhythm can be scary. It's important to address these feelings; they don't make you weak. Tell your healthcare team if you are struggling. Many people find support groups useful, and some benefit from talking to a counsellor or psychologist.

Prevention

You cannot always prevent AFib, especially if it runs in your family or is linked to aging. But you can lower your risk by keeping your blood pressure under control, staying at a healthy weight, limiting alcohol, avoiding smoking, and managing diabetes. Treating sleep apnea and reducing stress also help.

Vaccines

Stay up to date with recommended vaccinations, including the flu and COVID-19 vaccines, because infections can sometimes trigger AFib episodes or make existing AFib worse.

Screening programmes

There is no routine screening test for AFib in the general public, but your doctor may check your pulse or do an ECG if you have risk factors. Some smartwatches and home blood pressure monitors can detect an irregular pulse, but they cannot diagnose you. Always follow up with your doctor if you notice an irregular warning.

Complications

If left untreated

• Stroke – blood clots that form in the quivering heart can travel to the brain
• Heart failure, which means your heart can't pump blood well enough to meet the body's needs
• Frequent fainting or falls due to dizzy spells
• Gradual worsening of symptoms and reduced quality of life

Long-term outlook

The outlook for AFib is generally positive with proper treatment and self-care. Most people can manage their symptoms well and sometimes even live for years without serious complications. The key is to follow your doctor's plan, take stroke prevention seriously, and stay on top of regular check-ups. Many people continue to enjoy travel, work, hobbies, and an active sex life. You are not alone – with the right support, AFib is very manageable.

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