“Every once in a while, my heart seems to be jumping out of my chest, I get a weak feeling and short of breath,” the patient explained. When I listened with my stethoscope, his rhythm was different than the usual lub-dub, foot-tapping, sounds, which are regular as a band marching through town on a summertime parade. Instead his heart had the irregular rhythm of popping corn, chaotic and unpredictable, and I couldn’t tap my foot to it.
As predicted, the EKG showed the rhythm of atrial fibrillation, with the atrial rate running at three to 400 beats per minute, and the ventricular rhythm chaotic, as the experts say, irregularly-irregular at about 150 beats per minute. Atrial fibrillation, or A Fib, is the most common abnormal heart rhythm condition. It afflicts about one percent of the total population, more than two million people in the U.S., and eight percent of all those older than 80 years of age.
There are many causes for A Fib, including long standing high blood pressure, coronary artery blockage, sleep apnea, too tight or leaky heart valves, too much or too little thyroid hormone, blood clots to the lung, an inherited conduction system or wiring condition, excessive amounts of tobacco, coffee, alcohol, or amphetamine, a viral infection involving the heart, stress of any kind, or just an old and weak heart.
There are two main reasons we need to do something about this rhythm abnormality. Most devastating can be the clots that can form in the atria since they are not emptying effectively, resulting in something like 10 to 25 percent of all strokes to the brain. Second, the ventricles are not efficient pumps when atria are fibrillating and even worse so when the ventricles are beating at 150 beats a minute.
So, with A Fib we must slow the heart down, thin the blood to prevent strokes, and sometimes even bring the rhythm back to normal when we can. While we are at it, in each case, physicians need to study why A Fib happened. It is a complex and interesting condition, and there is a lot of debate about what kind of blood thinners to prescribe, what kind of rhythm-control drugs to use, and when to use surgery and pacemaker treatments.
But the bottom line about A Fib is that good treatment by your general or cardiology physician can prevent problems and allow a normal life, even with the heart rhythm as irregular as popping corn.