Arrhythmia is a medical condition characterized by a problem with the rate or rhythm of the heartbeat. The most common form of arrhythmia is atrial fibrillation (AF).
Rapid, disorganized electrical signals cause the heart’s two upper chambers, called the atria, to fibrillate—to contract rapidly and irregularly. As a result, blood is not completely pumped into the lower chambers, called ventricles, and the two sets of chambers do not work together the way they normally do.
Dr. Seth Baker, a Doctor of Osteopathic Medicine with a specialty in cardiology who has offices in Vero and Sebastian, sees many patients with AF; “After burst blood vessels in the head and neck, it’s the leading cause of stroke in this country,” Dr. Baker says. It currently affects 2.5 million Americans.
AF may cause chest pain and even heart failure; even if no symptoms are present, it can increase the risk of stroke. AF can be persistent or intermittent – Dr. Baker cautions against thinking of intermittent AF as less serious; he says that the risk of stroke is as high as or perhaps even higher than it is with the persistent type.
Physicians diagnose AF by a review of signs and symptoms (if there are any), reviewing the patient’s medical history, and physical examination. There are also tests use to diagnose AF:
• Electrocardiogram (ECG). Small sensors are attached to the chest and arms to record electrical signals traveling through the heart.
• Holter monitor. A lightweight portable ECG device is carried on the body and records the heart’s activity for 24 hours or longer.
• Echocardiogram. Non-invasive test in which sound waves are used to provide a video image of the heart; this detects underlying structural heart disease.
• Blood tests can help rule out thyroid disease or other substances in the blood which can lead to AF.
• Chest X-Ray to see the condition of the heart and lungs.
Risk factors for AF, as described by the Mayo Clinic, include:
• Aging. While only approximately 3 percent of 60 year-olds have AF, the frequency increases to 12 percent for those age 80 and up.
• Heart disease. Increased risk is associated with all types of heart disease, including valve problems, congestive heart failure, coronary artery disease, or a history of heart attack or heart surgery.
• High blood pressure, especially if it’s uncontrolled.
• Other chronic conditions, including thyroid problems, sleep apnea, diabetes, chronic kidney disease, and lung disease.
• Alcohol. Drinking alcoholic beverages may trigger an episode of AF. Binge drinking increases the risk.
• Obesity increases the risk of AF.
• Family history. An increased risk is present in some families.
Risk can be assessed using the CHADS score, an acronym for
Congestive Heart Failure History,
Hypertension History,
Age 75 or older,
Diabetes, and
Stroke or TIA.
“Stroke is given two points, the other factors are given one point each,” Dr. Baker explained. “A score of 2 or higher indicates a high risk for atrial fibrillation.”
Even with established diagnostic techniques, Dr. Baker says AF often goes undiagnosed. “That’s very challenging,” he says. “Treating a condition is easy, but the best physicians want to prevent something from happening in the first place. That’s why a regular assessment of a patient’s risk factors is so important.”
Treatment plans depend on how long the condition has existed, how bothersome it is, and any underlying causes. One goal of treatment is to reset the rhythm and control the rate of the heartbeat; cardioversion is a common technique.
In cardioversion, an electrical shock is delivered to the heart through paddles or patches placed on the chest, momentarily stopping the heart’s electrical activity. This process may be able to reset the heart rate and rhythm, depending on how long the patient has had AF and any underlying causes. Another form of cardioversion uses anti-arrhythmic medications to restore normal rhythm.
Catheter ablation may be used as an alternative to cardioversion, or if cardioversion is not effective. In this minimally invasive procedure, a thin, flexible tube is inserted into the blood vessels and gently guided to the heart. The physician then destroys tiny areas in the heart that are firing off abnormal electrical impulses. Ablation can relieve symptoms and improve quality of life. “Ablation is an option, especially for patients with intermittent AF, but it’s not for everyone,” says Dr. Baker.
Another AF treatment goal is the prevention of blood clots, as clots can lead to a stroke. Blood-thinning medications (anti-coagulants) can be prescribed; perhaps the most familiar is warfarin – brand name Coumadin. It was first approved for human use way back in 1954 and while it is an effective treatment, its drawbacks are well known:
• The optimal dose varies from patient-to-patient depending on age, diet and other medications being taken.
• The dosing is “delicate,” too much and there’s an increased risk of bleeding; too little and the risk of blood clots and stroke remains. As a result, patients must get blood tests at least monthly.
• Patients need to watch their intake of vitamin K. High levels are found in kale, collards, spinach, and various greens – turnip, mustard, beet. Too much vitamin K in the blood can reduce warfarin’s effectiveness.
In the last four years, three new drugs for the prevention of blood clots in patients with AF have been approved by the FDA. “These new drugs have advantages,” Dr. Baker says. “They don’t require regular blood tests and there are no vitamin K restrictions.” But Coumadin remains the only medication that has an antidote if blood levels rise too high, and it is a more affordable option.
If you suspect that you have AF, it’s important that you speak with an internist or cardiologist who will take the time to assess your risk, perform diagnostic tests, and explain your treatment options. As Dr. Baker says, “Each case is different, based on age, risk factors, other conditions, and other medication being taken. Every patient is unique.”
Atrial fibrillation: hard to diagnose, easy to control
By MARIA CANFIELD
Correspondent
Arrhythmia is a medical condition characterized by a problem with the rate or rhythm of the heartbeat. The most common form of arrhythmia is atrial fibrillation (AF).
Rapid, disorganized electrical signals cause the heart’s two upper chambers, called the atria, to fibrillate—to contract rapidly and irregularly. As a result, blood is not completely pumped into the lower chambers, called ventricles, and the two sets of chambers do not work together the way they normally do.
Dr. Seth Baker, a Doctor of Osteopathic Medicine with a specialty in cardiology who has offices in Vero and Sebastian, sees many patients with AF; “After burst blood vessels in the head and neck, it’s the leading cause of stroke in this country,” Dr. Baker says. It currently affects 2.5 million Americans.
AF may cause chest pain and even heart failure; even if no symptoms are present, it can increase the risk of stroke. AF can be persistent or intermittent – Dr. Baker cautions against thinking of intermittent AF as less serious; he says that the risk of stroke is as high as or perhaps even higher than it is with the persistent type.
Physicians diagnose AF by a review of signs and symptoms (if there are any), reviewing the patient’s medical history, and physical examination. There are also tests use to diagnose AF:
· Electrocardiogram (ECG). Small sensors are attached to the chest and arms to record electrical signals traveling through the heart.
· Holter monitor. A lightweight portable ECG device is carried on the body and records the heart’s activity for 24 hours or longer.
· Echocardiogram. Non-invasive test in which sound waves are used to provide a video image of the heart; this detects underlying structural heart disease.
· Blood tests can help rule out thyroid disease or other substances in the blood which can lead to AF.
· Chest X-Ray to see the condition of the heart and lungs.
Risk factors for AF, as described by the Mayo Clinic, include:
· Aging. While only approximately 3 percent of 60 year-olds have AF, the frequency increases to 12 percent for those age 80 and up.
· Heart disease. Increased risk is associated with all types of heart disease, including valve problems, congestive heart failure, coronary artery disease, or a history of heart attack or heart surgery.
· High blood pressure, especially if it’s uncontrolled.
· Other chronic conditions, including thyroid problems, sleep apnea, diabetes, chronic kidney disease, and lung disease.
· Alcohol. Drinking alcoholic beverages may trigger an episode of AF. Binge drinking increases the risk.
· Obesity increases the risk of AF.
· Family history. An increased risk is present in some families.
Risk can be assessed using the CHADS score, an acronym for
Congestive Heart Failure History,
Hypertension History,
Age 75 or older,
Diabetes, and
Stroke or TIA.
“Stroke is given two points, the other factors are given one point each,” Dr. Baker explained. “A score of 2 or higher indicates a high risk for atrial fibrillation.”
Even with established diagnostic techniques, Dr. Baker says AF often goes undiagnosed. “That’s very challenging,” he says. “Treating a condition is easy, but the best physicians want to prevent something from happening in the first place. That’s why a regular assessment of a patient’s risk factors is so important.”
Treatment plans depend on how long the condition has existed, how bothersome it is, and any underlying causes. One goal of treatment is to reset the rhythm and control the rate of the heartbeat; cardioversion is a common technique.
In cardioversion, an electrical shock is delivered to the heart through paddles or patches placed on the chest, momentarily stopping the heart’s electrical activity. This process may be able to reset the heart rate and rhythm, depending on how long the patient has had AF and any underlying causes. Another form of cardioversion uses anti-arrhythmic medications to restore normal rhythm.
Catheter ablation may be used as an alternative to cardioversion, or if cardioversion is not effective. In this minimally invasive procedure, a thin, flexible tube is inserted into the blood vessels and gently guided to the heart. The physician then destroys tiny areas in the heart that are firing off abnormal electrical impulses. Ablation can relieve symptoms and improve quality of life. “Ablation is an option, especially for patients with intermittent AF, but it’s not for everyone,” says Dr. Baker.
Another AF treatment goal is the prevention of blood clots, as clots can lead to a stroke. Blood-thinning medications (anti-coagulants) can be prescribed; perhaps the most familiar is warfarin – brand name Coumadin. It was first approved for human use way back in 1954 and while it is an effective treatment, its drawbacks are well known:
· The optimal dose varies from patient-to-patient depending on age, diet and other medications being taken.
· The dosing is “delicate,” too much and there’s an increased risk of bleeding; too little and the risk of blood clots and stroke remains. As a result, patients must get blood tests at least monthly.
· Patients need to watch their intake of vitamin K. High levels are found in kale, collards, spinach, and various greens – turnip, mustard, beet. Too much vitamin K in the blood can reduce warfarin’s effectiveness.
In the last four years, three new drugs for the prevention of blood clots in patients with AF have been approved by the FDA. “These new drugs have advantages,” Dr. Baker says. “They don’t require regular blood tests and there are no vitamin K restrictions.” But Coumadin remains the only medication that has an antidote if blood levels rise too high, and it is a more affordable option.
If you suspect that you have AF, it’s important that you speak with an internist or cardiologist who will take the time to assess your risk, perform diagnostic tests, and explain your treatment options. As Dr. Baker says, “Each case is different, based on age, risk factors, other conditions, and other medication being taken. Every patient is unique.”
