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The “Silent” Stroke Trigger—You Can Have This Condition and Not Even Know It…

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When it comes to preventing stroke and heart-related disorders such as heart failure, it’s crucial to identify and properly treat “Afib”—short for atrial fibrillation, the most common type of abnormal heart rhythm. Unfortunately, a significant number of the estimated 3 million Americans who have Afib don’t even realize it.

Now: With new diagnostic and treatment approaches, one’s chances are greater than ever that this potentially dangerous condition can be spotted and stopped—if you receive the right tests and medical care. What you need to know…

WHEN AFIB IS SILENT

If you have Afib, it’s possible to experience a range of symptoms including a quivering or fluttering heartbeat…a racing and/or irregular heartbeat…dizziness…extreme fatigue…shortness of breath…and/or chest pain or pressure.

But Afib can also be “silent”—that is, symptoms are so subtle that they go unnoticed by the patient. Silent Afib is sometimes an incidental finding during a physical exam when the doctor detects an irregular heartbeat. It may also be suspected in patients with nonspecific symptoms such as fatigue or shortness of breath—especially in those with a family history of Afib or a condition such as high blood pressure or diabetes that increases risk for Afib. But whether the symptoms are noticeable or not to the patient, the risk for stroke and potentially heart failure remains just as high, so Afib needs to be diagnosed. 

To check for Afib: The standard practice has been to perform an electrocardiogram (ECG) for a few minutes in the doctor’s office to record the electrical activity driving the heart’s contractions. But if Afib episodes are intermittent, the ECG may be normal.

When Afib is suspected based on symptoms such as dizziness and/or palpitations or racing heartbeat, but the ECG is normal, doctors have traditionally recommended monitoring for 24 to 48 hours. This involves wearing a small device that is clipped to a belt, kept in a pocket or hung around your neck and connected to electrodes attached to your chest. But this approach, too, can miss occasional Afib episodes.

What works better: Longer-term monitoring. Research published in The New England Journal of Medicine found that Afib was detected in five times more patients when they were monitored for 30 days instead of only 24 hours. Guidelines from the American Heart Association now recommend Afib monitoring for 30 days within six months after a person has suffered a stroke with no known cause.  

New option: With a doctor’s supervision, mobile ECG devices (about the size of a cell phone) can now be used periodically to record 30-second intervals of your heart rhythm. Ask your doctor for details.

GETTING THE RIGHT TREATMENT

Afib almost always requires treatment. Besides the danger of stroke, the condition tends to worsen if left alone—symptoms become more troublesome, and normal rhythm is harder to restore.

There are numerous options depending on other risk factors, your treatment goals and your own preference. Treatment is chosen based on frequency and severity of symptoms and whether the patient already has heart disease. Examples…

Prevent stroke. To keep clots from forming, many patients need blood-thinning medications (anticoagulants). The old standby, warfarin (Coumadin), is effective but requires regular blood tests and dietary restrictions.

In recent years, a new generation of easier-to-use anticoagulants has appeared, including dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis). These newer drugs have no dietary restrictions and do not require routine blood tests. However, all anticoagulants carry the risk for bleeding, which is harder to stop with the newer drugs.    

Some patients at otherwise low risk for stroke may need only low-dose aspirin (such as 81 mg daily).

Slow down a rapid heart rate. This is usually done with a beta-blocker like atenolol (Tenormin) or a calcium channel blocker like amlodipine (Norvasc) or diltiazem (Cardizem).

Normalize heart rhythm. Anti–arrhythmic drugs, such as amiodarone (Cordarone), flecainide (Tambocor) and dofetilide (Tikosyn), are available. However, these are powerful drugs, with potentially serious side effects (such as dizziness and uncontrollable shaking), that can worsen rhythm abnormalities and must be used cautiously.

Ablation. Another option to normalize heart rhythm and reduce stroke risk is known as ablation. With this procedure, the doctor threads a series of catheters up a vein to the heart to destroy the tiny group of cells that generate electrical impulses that cause fibrillation.

The procedure may have to be repeated but may be a good alternative to lifelong drug treatment. Ablation used to be saved for patients who didn’t respond to drugs, but it’s being offered as first-line therapy nowadays for those who want to avoid lifelong medication.

New procedure: Just last year, the FDA approved a procedure that can sharply reduce Afib stroke risk—left atrial appendage occlusion places a plug in a tiny sac of the atrium where 90% of clots form.

Each of these procedures, which eliminates the need for long-term blood thinning, carries a small risk for serious complications, such as stroke, and is best performed in a hospital that has experience with the surgery and the resources and expertise to provide emergency backup if needed.

An anti-Afib lifestyle. The best way to cut your odds of developing Afib is to modify risk factors. If you have high blood pressure or sleep apnea, get effective treatment. If you’re obese, lose weight. Exercise regularly. If you have Afib, these steps will make your treatment work better—and reduce symptoms.

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Source: Source: Walid Saliba, MD, medical director of the Center for Atrial Fibrillation and director of the Electrophysiology Lab at Cleveland Clinic. His research has been published in many  journals, including Circulation: Arrhythmia and Electrophysiology and American Journal of Cardiovascular Drugs. Date: October 1, 2016 Publication: Bottom Line Health
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