Signs and Symptoms of Atrial Fibrillation

Signs and symptoms of atrial fibrillation can vary in severity, ranging from subtle fatigue and weakness to serious and life-threatening conditions such as stroke and digital infarcts.

Atrial fibrillation, also known as AFib, is a condition where the atria of the heart send a high number of electrical impulses to the AV node and ventricles, resulting in rapid and irregular heart contractions.

This can cause palpitations, where the person feels their own heartbeats. To better understand the symptoms of atrial fibrillation, it’s important to have a clear understanding of what atrial fibrillation is and how it affects the heart’s normal electrical impulses.

Signs and symptoms of atrial fibrillation:

The signs and symptoms of atrial fibrillation can arise from three main reasons:

• Directly due to atrial fibrillation itself.
• As a result of complications arising from atrial fibrillation.
• As a result of medications used in the treatment of atrial fibrillation.

Please note that in this discussion, we will not be covering symptoms that may arise from underlying causes of atrial fibrillation, such as uncontrolled asthma, COPD, hyperthyroidism, and other related conditions.

Signs and Symptoms Directly Due to Atrial Fibrillation:

The following signs and symptoms are directly due to the irregular and fast heart beating as occurs in patients with atrial fibrillation:

• Palpitations:

Palpitations in AFib occur due to the irregular electrical signals in the atria of the heart, which result in a rapid, irregular, or fluttering heartbeat. Irregular heartbeats can cause the heart to beat too fast, too slow, or in an unpredictable pattern.

• How to differentiate it from other diseases:

Palpitations can be a symptom of other heart conditions or medical issues, such as anxiety, thyroid disorders, or other arrhythmias.

However, in AFib, palpitations are typically associated with an irregular heartbeat that may come and go, and they may be persistent or worsen over time.

• How to manage palpitations:

If you experience palpitations, it’s important to consult with a healthcare professional for proper evaluation and diagnosis.

The management of palpitations in AFib may include medications to control the heart rate, restore normal heart rhythm, or blood thinners to reduce the risk of stroke.

Lifestyle changes, such as avoiding triggers that may worsen palpitations (e.g., caffeine, alcohol), managing stress, and maintaining a healthy lifestyle, may also be recommended.

• Irregular heartbeat:

AFib is characterized by an irregular heartbeat, where the atria of the heart do not contract in a coordinated manner, resulting in an erratic and chaotic heartbeat. This can lead to an irregular rhythm with varying heart rates.

• How to differentiate it from other diseases:

The irregular heartbeat in AFib can be distinguished from other conditions by its distinct pattern of irregularity.

Unlike some other arrhythmias, such as sinus arrhythmia or premature atrial contractions (PACs), which may cause temporary irregularities in heart rate, AFib typically presents with persistent and irregular heartbeats that may be rapid or slow.

• How to manage erratic heartbeats:

Management of irregular heartbeat in AFib may involve medications to control heart rate, restore normal heart rhythm (e.g., antiarrhythmic drugs), or blood thinners to reduce the risk of stroke.

In some cases, medical procedures such as cardioversion (electrical shock to restore normal rhythm) or ablation (destroying abnormal heart tissue) may be recommended.

Lifestyle changes, such as avoiding triggers, managing stress, and maintaining heart-healthy habits, may also be important.

• Fatigue and weakness:

AFib can disrupt the normal flow of blood through the heart, reducing its ability to pump blood efficiently to the rest of the body.

This can result in decreased oxygen and nutrient supply to the muscles and tissues, leading to fatigue and weakness.

• How to differentiate it from other diseases:

Fatigue and weakness can be common symptoms in many health conditions including anemia, diabetes, and muscular/ skeletal conditions.

However, in AFib, they may be associated with an irregular heartbeat and other related symptoms, such as palpitations and shortness of breath.

• How to manage the symptoms of fatigue and weakness:

Managing fatigue and weakness in AFib may involve treating the underlying cause of AFib, such as controlling heart rate and rhythm with medications or medical procedures.

Lifestyle changes, such as improving sleep quality, managing stress, and maintaining a healthy diet and exercise routine, may also help reduce fatigue and weakness.

• Shortness of breath:

AFib can cause the heart to pump less effectively, leading to reduced blood flow to the lungs and other parts of the body.

This can result in a sensation of breathlessness or difficulty breathing, especially during physical activity or exertion.

In addition, fluid may start accumulating in the lungs which could lead to cough and shortness of breath especially while lying down. hence, people may notice that they get short of breath or develop a cough when they lie down straight.

• How to differentiate SOB of Afib from other diseases:

Shortness of breath can be a symptom of various heart and lung conditions. However, in AFib, it may be associated with an irregular heartbeat and other symptoms, such as palpitations and fatigue.

It may also worsen during episodes of AFib, and improve with treatment to restore normal heart rhythm or control heart rate.

• How to manage the SOB of Afib:

Managing shortness of breath in AFib may involve treating the underlying cause of AFib, such as controlling heart rate and rhythm with medications or medical procedures.

Lifestyle changes, such as avoiding triggers that worsen shortness of breath (e.g., smoking, exposure to air pollutants), maintaining a healthy weight, and engaging in regular physical activity as tolerated, may also be recommended.

Reducing salt intake to avoid fluid accumulation is essential. In some cases, supplemental oxygen or pulmonary rehabilitation may be helpful in addition to water pills (diuretics) that help your body excrete the excess fluid in your body via urine.

• Dizziness and lightheadedness:

AFib can disrupt the normal flow of blood to the brain, reducing oxygen and nutrient supply to the brain tissues, and leading to dizziness and lightheadedness.

The irregular heartbeats in AFib can also affect blood pressure and cause fluctuations that may contribute to these symptoms.

• How to differentiate it from other diseases:

Dizziness and lightheadedness can be caused by various conditions, including other heart or neurological disorders, low blood pressure, or dehydration.

However, in AFib, they may be associated with an irregular heartbeat and other related symptoms, such as palpitations and shortness of breath.

• How to manage the symptom:

Managing dizziness and lightheadedness in AFib may involve treating the underlying cause of AFib, such as controlling heart rate and rhythm with medications or medical procedures.

Lifestyle changes, such as maintaining adequate hydration, avoiding sudden changes in body position, and rising slowly from a sitting or lying position, may also be helpful.

In some cases, medications to manage blood pressure or other contributing factors may be prescribed.

• Chest pain or discomfort:

Chest pain or discomfort in AFib may be caused by reduced blood flow to the heart muscle due to the irregular heartbeat and reduced pumping efficiency of the heart.

It can also be associated with other heart conditions, such as angina, anxiety, and stress related to AFib diagnosis or symptoms.

• How to differentiate it from other diseases:

Chest pain or discomfort can be caused by various conditions, including other heart conditions, gastrointestinal issues, musculoskeletal problems, or anxiety.

However, in AFib, it may be associated with an irregular heartbeat and other related symptoms, such as palpitations and shortness of breath.

• How to manage the symptom:

Managing chest pain or discomfort in AFib may involve treating the underlying cause of AFib, such as controlling heart rate and rhythm with medications or medical procedures.

Lifestyle changes, such as avoiding triggers that worsen chest pain (e.g., heavy meals, stress), managing stress, and maintaining heart-healthy habits, may also be recommended. In some cases, medications to manage chest pain or anxiety may be prescribed.

• Anxiety and stress:

Anxiety and stress can result from the diagnosis of a chronic condition like AFib, as well as from the physical symptoms and lifestyle changes associated with AFib.

The fear of complications, such as stroke or embolism, can also contribute to anxiety and stress in AFib.

• How to differentiate it from other diseases:

Anxiety and stress can be caused by various factors, including other medical conditions, life events, or lifestyle factors.

However, in AFib, anxiety and stress may be specifically related to the diagnosis of AFib, the physical symptoms experienced, and the fear of potential complications.

• How to manage anxiety and stress:

Managing anxiety and stress in AFib may involve a combination of lifestyle changes and psychological interventions.

This may include relaxation techniques, stress-reducing activities such as meditation or yoga, cognitive-behavioral therapy (CBT), and counseling or therapy to address the emotional impact of living with AFib.

Medications to manage anxiety or stress may also be prescribed in some cases.

Signs and Symptoms Due to the COmplications of Atrial Fibrillation:

Atrial fibrillation (AFib) is a condition that can lead to various complications. Some of the most common complications associated with AFib include:

• Stroke:

AFib significantly increases the risk of stroke. In AFib, blood can pool in the atria due to irregular heartbeat and form blood clots.

These blood clots can then travel to the brain and block blood flow, leading to a stroke. Strokes associated with AFib tend to be more severe and have a higher risk of disability or death compared to strokes from other causes.

• Symptoms of stroke in Afib:

Symptoms of stroke in Afib are not different from stroke due to any other reason. These symptoms include numbness or weakness of one part of the body (face, arm, or leg), difficulty speaking or making up words, confusion, double vision or trouble seeing things, headache, loss of balance and coordination, fatigue, mood swings, memory loss, and loss of consciousness.

• Management:

To reduce the risk of stroke, doctors may prescribe blood-thinning medications such as warfarin, direct oral anticoagulants (DOACs) such as Eliquis (Apixaban), Dabigatran, or Xarelto (Rivaroxaban), or antiplatelet drugs, depending on the individual’s risk factors.

Lifestyle changes, such as managing high blood pressure and diabetes, may also be recommended.

• Heart Failure:

AFib can weaken the heart muscle over time, leading to heart failure. The irregular heartbeat and inefficient pumping of blood can cause the heart to work harder, leading to enlargement of the heart chambers and reduced cardiac function.

• Symptoms of heart failure in Atrial fibrillation:

The symptoms of heart failure in Afib may include coughing and shortness of breath which worsen on lying down straight (at night), wheezing, body swelling (legs and eye swelling), increased need to urinate at night (getting up at night to pee), weight gain, chest pain, fatigue, exercise intolerance, and getting short of breath while talking.

• Management:

Treating the underlying AFib, such as controlling heart rate and rhythm with medications or medical procedures, can help manage heart failure in AFib.

Lifestyle changes, such as managing fluid intake and following a heart-healthy diet, may also be recommended. Medications to manage heart failure, such as diuretics, beta-blockers, or ACE inhibitors, may also be prescribed.

• Blood Clots and Pulmonary Embolism:

In addition to the risk of stroke, blood clots can also form in the veins, especially in the legs, due to blood stasis caused by AFib.

These blood clots can travel to the lungs and cause a blockage, leading to a potentially life-threatening condition called pulmonary embolism.

• Symptoms of Blood Clots and Pulmonary embolism:

Symptoms of pulmonary embolism in Afib may include a sudden onset of shortness of breath, chest pain, cough, hemoptysis (coughing out blood), cyanosis (bluish discoloration of the lips, tongue, and limbs), lightheadedness, syncope, low blood pressure, sweating, and a sense of impending doom.

Blood clots may travel from the heart to the arms and legs and patients may develop sudden onset of blackish discoloration of the hands and feet, or the digits, and severe pain in the fingers or toes depending on where the clot has traveled, loss of pulses in the affect parts, the area become cold, and gangrene formation.

• Management:

Blood-thinning medications and anticoagulants such as Xarelto and Eliquis are usually used to prevent blood clots, however, they may also be used to treat blood clots once they develop.

• Cardiac Arrest:

In rare cases, AFib can degenerate into a fast and irregular heart rate, leading to a life-threatening condition called ventricular fibrillation, which can result in cardiac arrest.

Cardiac arrest is a medical emergency and requires immediate medical attention, including cardiopulmonary resuscitation (CPR) and defibrillation.

• Management:

Emergency medical care and prompt treatment of ventricular fibrillation, including CPR and defibrillation, are critical in managing cardiac arrest in AFib.

• Cognitive Impairment and Dementia:

Some studies have shown that AFib may increase the risk of cognitive impairment and dementia, possibly due to reduced blood flow to the brain from embolic events or other mechanisms.

However, the relationship between AFib and cognitive impairment is complex and further research is needed to fully understand it.

• Management:

Managing AFib and its risk factors, such as controlling blood pressure, managing blood sugar levels, and adhering to a healthy lifestyle, may potentially help reduce the risk of cognitive impairment and dementia.

Regular cognitive assessments and close monitoring by healthcare professionals may also be recommended.

• Other complications:

AFib can also cause other complications, such as chest pain, palpitations, dizziness, and reduced exercise tolerance, which can impact a person’s quality of life.

• Management:

Treating the underlying AFib, managing symptoms, and addressing any associated risk factors or complications, as discussed earlier, can help manage these additional complications.

Signs and Symptoms Related to the Side Effects of Drugs Used to Treat Atrial Fibrillation:

Here are some commonly used drugs for the treatment of atrial fibrillation (AFib) categorized into different classes:

Drugs for Rate Control:

• Beta-blockers (e.g., metoprolol, propranolol):

These drugs slow down the heart rate by blocking the action of adrenaline on the heart. They are often used as first-line agents for rate control in AFib.

• Calcium channel blockers (e.g., diltiazem, verapamil):

These drugs also help slow down the heart rate by blocking calcium channels in the heart muscles. They are commonly used as an alternative to beta-blockers or in combination with them for rate control in AFib.

• Digoxin:

This drug helps to slow down the heart rate and may be used in certain situations, but it is less commonly used nowadays due to its potential side effects and limited effectiveness.

Drugs for Rhythm Control:

• Antiarrhythmic drugs (e.g., amiodarone, Dronedarone, flecainide, propafenone):

These drugs are used to restore and maintain normal heart rhythm (sinus rhythm) in AFib. They work by suppressing abnormal electrical signals in the heart that cause AFib. However, they are associated with potential side effects and require careful monitoring.

• Electrical cardioversion:

This procedure involves the use of electrical shocks to restore normal heart rhythm in AFib. It may be done in combination with antiarrhythmic drugs or as a standalone treatment.

Drugs for Heart Failure:

• ACE inhibitors (e.g., lisinopril, enalapril):

These drugs help to dilate blood vessels, reduce fluid buildup, and lower blood pressure, thereby improving heart function and managing heart failure in AFib.

• Angiotensin receptor blockers (ARBs) (e.g., Losartan, Candesartan, Telmisartan, Valsartan, Irbesartan):

These drugs work similarly to ACE inhibitors by blocking the effects of a hormone called angiotensin, which can cause blood vessels to constrict and increase blood pressure.

• Diuretics (e.g., furosemide, eplerenone, spironolactone, hydrochlorothiazide):

These drugs help to remove excess fluid from the body, reduce fluid buildup, and relieve symptoms of heart failure, such as swelling and shortness of breath.

Blood Thinners:

• Warfarin:

This is a vitamin K antagonist that has been used for many years to prevent blood clots in AFib. It requires regular monitoring of blood levels and dose adjustments.

• Direct oral anticoagulants (DOACs) (e.g., apixaban, dabigatran, rivaroxaban, edoxaban):

These newer blood-thinning medications are given in fixed doses and do not require regular monitoring. They are often preferred over warfarin due to their convenience and similar efficacy in preventing strokes in AFib.

Other Drugs Which Reduce Cardiovascular Mortality in AFib:

• Statins (e.g., atorvastatin, rosuvastatin, simvastatin):

These drugs are used to lower cholesterol levels and reduce the risk of cardiovascular events, such as heart attack and stroke, in patients with AFib and other cardiovascular risk factors.

• Antiplatelet drugs (e.g., aspirin, clopidogrel):

These drugs may be used in certain cases where blood thinners are contraindicated or not tolerated, but they are less commonly used for stroke prevention in AFib compared to blood thinners.

The side effects of these drugs are summarized in the table below:

Summary of the Signs and Symptoms of Atrial Fibrillation:

The table below summarizes the signs and symptoms of atrial fibrillation: