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How AFib can present as a heart attack or stroke

Posted on Tuesday March 5, 2024 in Naked Heart

An article by Dr Edward Leatham, Consultant Cardiologist, author of The Naked Heart  a series of simple blog and video explanations covering all of the main common medical conditions that can affect us, as we age.

Understanding the Presenting Features of Atrial Fibrillation

Atrial fibrillation, commonly referred to as AFib, is a cardiovascular condition that manifests in various ways, significantly influenced by how the atrial rate is moderated by the atrioventricular node and, to some extent, the individual’s perception of their heart rhythm. This atrial impulses typically revolves around 600 cycles per minute. Understanding the factors that dictate its clinical presentation is important for timely diagnosis and management, given the condition’s potential to cause severe complications like stroke and heart attacks.

The Elusive Nature of Atrial Fibrillation Symptoms

Many individuals with atrial fibrillation, especially those who experience lower pulse rates while in this state, might not even be aware that they have the condition. This lack of awareness is concerning, as it elevates the risk of stroke. Blood clots can begin to form within the left atrium if atrial fibrillation persists for more than 24 hours, posing a significant risk.

The Role of the Left Atrial Appendage

During atrial fibrillation, the left atrium exhibits uncoordinated movements, but the primary concern is the left atrial appendage, a small extension of the left atrium. Even under normal conditions, this area experiences reduced blood movement, which worsens during fibrillation. The resultant stasis in the left atrium, particularly in the appendage, is where blood clots typically originate. Upon the restoration of normal sinus rhythm, these clots can detach and enter the bloodstream, leading to embolization in critical arteries.

The Path of Embolization and Its Consequences

When clots from the left atrial appendage dislodge, they can travel to various parts of the body, including the coronary artery, which receives about 5% of the blood from each heartbeat, or the cerebral arteries, accounting for approximately 20% of each cardiac cycle’s output. The location where a clot lodges can have significant implications. If a clot obstructs the coronary arteries or cerebral arteries, it can lead to catastrophic outcomes like heart attacks or strokes, respectively, drastically affecting the individual’s quality of life and requiring urgent medical intervention.

The Imperative of Prevention and Management

Given the severe repercussions of atrial fibrillation, it’s imperative for individuals, especially those at risk, to undergo regular monitoring for early detection. Healthcare providers play a critical role in educating patients about the potential symptoms and the importance of timely medical consultation if they suspect something is amiss. Effective management strategies, including medication, lifestyle changes, and possibly surgical interventions, are essential to mitigate the risks associated with this condition.

In conclusion, atrial fibrillation is a complex cardiovascular disorder with varied presentations and significant risks. Its management is pivotal in preventing severe outcomes like strokes and heart attacks. Through awareness, early detection, and proactive treatment, the dangers associated with atrial fibrillation can be significantly reduced, enhancing patient outcomes and quality of life.

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