Many of us have felt a flutter in our chest at one time or another. However, if you experience a fast or irregular heartbeat, you may have atrial fibrillation (AF). While the condition can be uncomfortable, the good news is that treatments are readily available. We asked a specialist in cardiology, Professor Lau Chu Pak, to talk us through those treatments and sort out truth from fiction when it comes to AF medication, exercise and heart health.
Myth #1: Atrial fibrillation only appears in people who suffer from other heart diseases
Atrial fibrillation (AF) is characterised by an irregular heartbeat and often a very rapid heart rhythm, which is a kind of arrhythmia. Many people think that AF only appears in those with heart diseases. While it’s true that people with medical conditions like high blood pressure or coronary artery disease are at higher risk, there are also patients with atrial fibrillation may not have known heart diseases or heart damage – particularly those at an advanced age or who are obese or use alcohol excessively and so on.
Myth #2: Patients will recover without AF medication
Some people with atrial fibrillation may not present with any symptoms at all; their abnormal heartbeats get detected accidentally during a general body check. Others may experience symptoms occasionally, such as chest pain, dizziness and so on, which can last for minutes or hours. This is called paroxysmal atrial fibrillation.
When a patient is diagnosed with AF, the doctor will prescribe medication to control the heart rate and its irregularity, in order to maintain the heart rhythm and prevent stroke respectively. For those who have a specific triggering cause for the condition – for example, if the patient suffers from thyrotoxicosis – AF may go away after the triggering cause is treated and controlled.
Myth #3: Atrial fibrillation patients should not do exercise
Many AF patients are worried about whether or not they should exercise. It depends on how well AF is controlled. Patients with well-controlled AF can do exercise – in general, it is unlikely that exercising will make things worse. Indeed, under the right precautions, exercise can enhance heart health. However, the condition of different individuals varies, so it’s recommended to consult a doctor beforehand.
Myth #4: Patients can feel their irregular heartbeat or abnormalities
For AF patients, the upper chamber beats at or above 350 beats per minute. In general, only one in ten AF patients can feel the heartbeat irregularities, especially those with underlying structural heart diseases. Some AF cases are found with the use of smart devices. Atrial fibrillation can be an emergency, so if you are having an irregular heartbeat or experiencing chest pain, it’s recommended to see a doctor immediately.
Myth #5: Atrial fibrillation is harmless
During AF, the upper chamber is beating at 350 beats per minute or above, which means the heart is not effective in pumping. Clots may form in the upper chamber of the heart, and then disseminate into the circulation. When it goes up to the brain, it can cause a stroke. The AF patients are at higher risk of stroke than the people without AF. Hence, anticoagulants are prescribed as part of the medication to reduce the risk of stroke, which is one of the treatment goals.
Myth #6: People using traditional anticoagulants cannot change to a newer treatment
In the past, traditional anticoagulants like warfarin have commonly been used for stroke prevention. However, since these are vitamin-K-dependent drugs, regular blood monitoring is needed due to food and drug interactions. Recently, several non-vitamin-K-dependent anticoagulants have become available. As there are fewer interactions with food and medications, repeated blood monitoring is not required. This new generation of oral anticoagulants have been shown to be superior to the traditional anticoagulants, and there is significantly less bleeding, including bleeding in the brain.
When patients switch from warfarin to newer oral anticoagulants as their treatment, the effect of warfarin will wear off within one or two days after stopping the medications. Patients can start the new medications after waiting for this short period. However, there are certain indications that patients may need to stick with traditional anticoagulation. Such as those with mechanical heart valve replacements or rheumatic heart disease with very severe narrowing of blood vessels – so-called mitral stenosis.
Myth #7: A smart watch is not accurate enough to be a diagnostic tool
Many people consider wearable devices to be a ‘health monitor’ that enables them to take charge of their own health. And it’s true that the monitoring tool in smart watches and other consumer electronic devices is quite useful as an initial indicator of an irregular heartbeat. However, it’s mostly useful for those people who have either undergone ablation as a treatment for atrial fibrillation or those who are receiving medication to monitor their heartbeat.
When an irregular heart rhythm is spotted via a device, the best response is to seek consultation with a doctor. A check-up may be suggested for diagnosis. Treatment would then be tailored to control the heart rhythm and prevent stroke from happening.
The above information is provided by Professor Lau Chu Pak, Specialist in Cardiology.
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