Improving Stroke Prevention in Patients With Atrial Fibrillation
Atrial fibrillation and stroke
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Transcript of Atrial fibrillation and stroke
Atrial Fibrilla*on and Stroke
Dr. Sunil Garg Cardiologist ASAP 2014
Atrial Fibrilla*on
• Abnormal rhythm of the heart • Very common problem • Over the age of 40 – one in four chance of developing atrial fibrilla*on
• More frequent in men than in women
Atrial Fibrilla*on
• Affects the atria or upper chambers of the heart
• Electrical impulses do not properly circulate through the heart
• Make your heart beat too quickly, too slowly or in an uneven fashion
Electricity of the Heart
Atrial Fibrilla*on
• Two Forms • IntermiQent (Paroxysmal) – Episodes that occur with varying frequency or last for a variable period of *me before spontaneously stopping
• Chronic (Persistent) – Sustained and usually does not stop
Cause of Atrial Fibrilla*on
• Increases in frequency with aging and typically occurs in people with underlying heart disease
• Most common causes – Chronic high blood pressure (hypertensive heart disease)
– A heart aQack – Heart Valve Disease (MS or MR) – A complica*on of heart surgery
Atrial Fibrilla*on and Alcohol
• Binge drinkers can usually develop atrial fibrilla*on that is usually transient
• OWen occurs over weekends or holidays when alcohol intake is excessive
• “Holiday Heart Syndrome”
Atrial Fibrilla*on and Hyperthyroidism
• Occurs in 13 percent of people with an overac*ve thyroid
• Accounts for 5% of all cases of atrial fibrilla*on
• Make sure your thyroid levels are checked • Treatable and reversible cause
Atrial Fibrilla*on due to S*mulants
• Drugs that s*mulate the heart can contribute to the development of atrial fibrilla*on
• Caffeine • Tobacco
Atrial Fibrilla*on and Sleep Apnea
• Condi*on where pa*ents stop breathing for prolonged periods while sleeping
• Overweight • History of Snoring • Excessive Sleepiness during the day*me • Treatment can eliminate atrial fibrilla*on
Atrial Fibrilla*on and Lung Disease
• Chronic Lung Diseases can cause Atrial Fibrilla*on
• Par*cularly seen in pa*ents with emphysema
Lone Atrial Fibrilla*on
• Some people with atrial fibrilla*on have no apparent cause
• Structurally normal heart
Atrial Fibrilla*on Symptoms
• Mild Symptoms – Unpleasant palpita*ons or irregularity of the heart – Mild chest discomfort / sensa*on of *ghtness – A sense of racing heart – Lightheadedness – Mild shortness of breath and fa*gue that limit the ability to exercise
Atrial Fibrilla*on and Symptoms
• Severe Symptoms – Difficulty breathing – Shortness of breath with exer*on – Fain*ng or near fain*ng – Confusion – Chest Discomfort – Fa*gue
Atrial Fibrilla*on and Risk of Stroke
• Chao*c rhythm may cause blood to pool in your hearts upper chambers
• This leads to clot forma*on
Atrial Fibrilla*on and Risk of Stroke
• Serious complica*on from Atrial Fibrilla*on
• Can lead to permanent brain damage
• Clot may also travel to – Eye – Kidneys – Spine – Important arteries in the arms or legs
Risk Factors for Stroke
• CHADS2 – Conges*ve Heart Failure – Hypertension – Age (65 to 74 versus >75)
– Diabetes – Previous Stroke or TIA
Atrial Fibrilla*on and Heart AQack
• People who have a heart aQack are at risk for developing Atrial Fibrilla*on
• Having atrial fibrilla*on doubles your chances of having a heart aQack
Atrial Fibrilla*on and Heart Failure
• If not controlled, can weaken the heart and lead to heart failure
• Usually improves with treatment and control of the heart rate
Atrial Fibrilla*on Diagnosis
• Electrocardiogram • Holter Monitor • Event Recorder • Echocardiogram
Atrial Fibrilla*on Treatment
• Short Term Treatment – Rate Control – Cardioversion
• Transesophageal Echocardiogram
Atrial Fibrilla*on Treatment
• Short Term Treatment – Rate Control – Cardioversion
• Transesophageal Echocardiogram
Atrial Fibrilla*on Treatment
• Long Term Treatment – Rhythm Control
• Efforts to restore and maintain a normal rhythm are made • Can be done via
– Cardioversion – An*arrhythmic Drugs – Abla*on Procedure
Rhythm Control
• Advantages – Improved cardiac func*on
– Reduced Symptoms for some people
– Reduced need for medica*ons
• Disadvantages – High rate of recurrence of atrial fibrilla*on
– Side effects of medica*ons (AAD)
– Adverse effects of medica*ons
Atrial Fibrilla*on Treatment
• Long Term Treatment – Rate Control
• Con*nue to have atrial fibrilla*on • Use medica*on to slow the heart rate down • Can be difficult to use medica*ons to slow the heart rate down
Nonpharmacological Treatment
• Radiofrequency Abla*on – Developing Procedure – Risk of Complica*ons
• Pacemaker – May be needed for a slow heart beat or to help with medica*ons
• Surgical Procedures – Complete MAZE Procedure
Atrial Fibrilla*on and An*coagula*on
• Increased risk of stroke as a result of blood clots that can form in the heart
• Most people are advised to use a treatment to reduce the risk of developing blood clots
• Most commonly used treatments include an*coagulants or an*platelet drugs
An*coagulant Drugs
• Can reduce the risk of stroke by 50 to 70% – Warfarin – Dabigatran (Pradaxa) – Apixaban (Eliquis) – Rivaroxaban (Xarelto)
An*platelet Drugs
• May be used in pa*ents with lower risks • May be used in pa*ents who are intolerant to an*coagulant drugs – Increased bleeding risk – Recurrent falls
• ASA 81 mg daily • Clopidogrel (Plavix) 75 mg daily
What Can You do?
• Monitor Your Blood Pressure • Control Your Diabetes • Take your Medica*ons / Blood Thinners if you have been diagnosed with Atrial Fibrilla*on
• See your doctor if you develop the symptoms listed
Thank You