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An Irregular Heartbeat Can Cause A Stroke

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Try these new approaches to protect yourself against atrial fibrillation…

If you have a type of irregular heartbeat known as atrial fibrillation (or “A-fib”), your increased risk for stroke and other serious conditions can be a frightening prospect to live with.

Good news: New guidelines to improve treatment for people with A-fib—the first such recommendations in nearly 10 years—have recently been released by the American College of Cardiology, the American Heart Association and the Heart Rhythm Society. The guidelines are important because they help ensure that A-fib patients are receiving the highest standards of care.

WHAT GOES WRONG

A-fib is a rapid and irregular heartbeat triggered when the upper chambers of the heart (atria) quiver erratically, sometimes faster than 300 times per minute.

Symptoms may include the sensation of a pounding or fluttering heart, chest pain, intense fatigue, shortness of breath for no apparent reason and/or sudden dizziness. However, in some cases, A-fib can be “silent”—with no symptoms at all.

A-fib is usually suspected based on a person’s symptoms and a physical exam. It is also sometimes discovered when a person undergoes routine heart tests, such as an electrocardiogram (ECG or EKG)…a stress test…or an echocardiogram. A definitive diagnosis of A-fib requires some type of ECG monitoring, which shows A-fib.

New treatment approaches…

IS MEDICATION RIGHT FOR YOU?

Stroke is the number-one problem caused by A-fib—but prescribing a blood-thinning medication (anticoagulant) to prevent stroke isn’t always straightforward—each drug has possible side effects that must be balanced against its benefits.

Fortunately, decision-making about drugs for A-fib just got a lot easier for doctors. Guidelines now endorse the use of a new medical calculator—the exact name is “CHA2DS2-VASc Score for Atrial Fibrillation Stroke Risk”—that includes several specific stroke risk factors, such as vascular disease and female gender, to more accurately predict who is likely to suffer a stroke and whether treatment with a blood thinner is right for the patient. Older risk calculators did not include these specific risk factors.

What to do: If you have been diagnosed with A-fib, tell your doctor that you want to check your stroke risk with the CHA2DS2-VASc Score to determine whether or not you should be on a blood-thinning medication to prevent a stroke. The calculator and instructions on how to use it are available online at many websites, including ClinCalc.com.

THE BLOOD THINNER QUESTION

The new guidelines also recommend for the first time that doctors treating patients with A-fib consider prescribing one of three blood-thinning drugs that have entered the marketplace in the last five years—dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis). A fourth new blood thinner called edoxaban (Savaysa) has been released since these guidelines were published and will be included in the next update. Although more expensive than warfarin (Coumadin), the standard blood thinner, these drugs may offer some advantages over it.

For more information on choosing the right blood thinner: See the Bottom Line Health article The Truth About Blood Thinners.

BEYOND STROKE PREVENTION

The frequency of A-fib symptoms can be eliminated or reduced with antiarrhythmic medication, such as flecainide (Tambocor) or propranolol (Inderal), or catheter ablation. With this procedure, a catheter (thin, flexible tube) is inserted through a vein in the groin and snaked into the heart. Radiofrequency energy is used to destroy “aberrant pacemaker” cells that send out irregular impulses that trigger A-fib.

For best results: The most successful outcomes occur in medical centers where the procedure is performed regularly. Guidelines also recommend that an electrophysiologist (a cardiologist who specializes in treating electrical problems of the heart) perform a minimum of two A-fib ablation procedures each month to maintain competency. There is no substitute for experience, for both the physician and ablation center, when it comes to complex cardiac procedures.

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Source: Hugh Calkins, MD, a professor of medicine and the Nicholas J. Fortuin M.D. Professor of Cardiology at The Johns Hopkins University School of Medicine, and director of Cardiac Arrhythmia Services and Electrophysiology Laboratory at The Johns Hopkins Hospital, both in Baltimore. He has published more than 500 scientific papers and book chapters and is an associate editor of the Journal of Cardiovascular Electrophysiology. Dr. Calkins is a past president of the Heart Rhythm Society. Date: August 1, 2015 Publication: Bottom Line Health