Causes and risk factors
Arrhythmias are caused due to disruption of the normal electrical conduction system of the heart. To fibrillate is to contract too fast and irregularly. Abnormal electrical signals in heart cause the two upper chambers of heart to fibrillate. It causes pooling of blood into the atria; the blood is not pumped into the lower chambers [ventricles], thus the upper and lower chambers do not contract effectively as they should, leading to AF. Causes of atrial fibrillation include high blood pressure, coronary artery disease, rheumatic heart disease, heart failure, valvular heart disease [especially mitral stenosis and mitral regurgitation], pericarditis, congenital heart defects, sick sinus syndrome, heart surgery, hypertrophic cardiomyopathy, overactive thyroid gland [hyperthyroidism]. Certain medications, Alcohol abuse [especially binge drinking] can also cause AF.
Clinical presentation
Types of AF are Paroxysmal– episodes lasting less than 24 hours and up to a maximum period of 1 week. Persistent– Episodes lasting for more than 1 week. Permanent– Both paroxysmal and Persistent AF can eventually lead to permanent AF. The patient may or may not be aware of AF symptoms. Symptoms include palpitations, shortness of breath while lying down. Patient complains of confusion, dizziness, light-headedness, fainting, and fatigue. Sometimes chest pain can also be experienced by the patient. Signs such as pulse may feel rapid, racing, pounding, fluttering, or too slow; it may be regular or irregular. The normal heart rate is 60 – 100, but in atrial fibrillation/flutter the heart rate may be 100 – 175. Blood pressure may be normal or low.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Tests that should be performed are ECG, Holter monitoring [Continuous ambulatory cardiac monitoring], and Stress test. Electrophysiologic study [EPS] is recommended. Imaging studies such as Echocardiogram, Nuclear imaging tests is useful for further evaluation. Coronary angiography is advised.
Treatment
People who have AF but don’t have symptoms or related heart problems may not require any treatment. Most people who have persistent or permanent AF need treatment to control their heart rate and prevent complications. Medications like blood thinning agents, medicines to slow down the heart rate, to control the heart rhythm are prescribed. Procedures like Electrical cardioversion- [low-energy shocks are given to the heart to trigger a normal rhythm.], Catheter ablation may be required. Further treatment consists of Pacemaker implant to help maintain a normal heart rhythm. Surgical intervention may be needed in case of valvular heart diseases or other heart conditions.
Other Modes of treatment
The other modes of treatment can also be effective in treating AF. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating AF.
