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When Your Heart Skips a Beat: Understanding Atrial Fibrillation

July 11, 2020

"The good news is that many of the things that lead to atrial fibrillation are completely preventable."

It may sound romantic as a turn of phrase, but when your heart skips a beat, it may not be a good thing. In today’s post, Dr. Keller Wortham, MD, will discuss a condition called atrial fibrillation, which can be deadly. We’ll learn some of the symptoms, when you should see your doctor, and some lifestyle steps you can take to prevent this condition and keep your heart beating the way it should.

Video Highlights

  • 01:29: Atrial Fibrillation Statistics
  • 02:45: Anatomy of the Heart
  • 05:50: Symptoms of Atrial Fibrillation
  • 07:13: Risks Associated with Atrial Fibrillation
  • 08:57: Preventing Atrial Fibrillation
  • 11:23: Wrap-Up

Have you ever felt your heart skip a beat? It can feel really disconcerting. Maybe you were nervous before a speech, or you had too much coffee, or maybe you were about to have a date with the love of your life. If this has happened before, that’s not necessarily a reason to worry. It's totally natural to feel your heart skip a beat every once in a while, but if that starts to happen more consistently or frequently, it can actually be an indication of a pretty serious condition. 

The term that we often use for a heart skipping a beat is a palpitation. It feels like a little flutter in your chest. However, the medical term that we use for palpitations that occur more frequently or go on for longer is arrhythmia

In today’s post, we’re going to talk about a very particular arrhythmia that is quite serious. There are some palpitations out there that aren't really a big deal, and there are others that can be life-threatening. The one we’re discussing today is called atrial fibrillation

Atrial Fibrillation Statistics

Let’s talk about some statistics regarding atrial fibrillation. Over three million people in the United States have been diagnosed with atrial fibrillation, but a lot more people out there may have it and not even be aware of it. Of those who know they have atrial fibrillation, about half of them don't know that it puts them at an increased risk of serious conditions like stroke, heart attack, pulmonary embolus, and even death. Additionally, a third of the people out there who know they have atrial fibrillation don't consider it a serious condition. 

In light of these facts, it’s very important to be informed about what atrial fibrillation is. At the most basic level, atrial fibrillation is an irregular heartbeat that bounces around and typically causes a pretty fast heartbeat. Your heart rate can go up to 150, or 175 beats per minute. Keep in mind, a normal heart rate is between 60 and 100 beats per minute. So, your heart rate is working really fast if it’s reached 150. So in order to understand what atrial fibrillation actually is, let’s do a quick review of the anatomy of the heart. 

Anatomy of the Heart

As you probably know, your heart sits in your chest just left of center, and is made up of four chambers. There are two chambers at the top, called the atria, and two larger chambers at the bottom called the ventricles. The heart is designed to function so that the upper chambers contract and push blood into the lower chambers, the lower chambers contract, and they send blood out into your body and to your lungs to get that circulation going. The heart also has a very intricate electrical wiring system that helps that coordination between the upper chambers and lower chambers occur. Essentially, some wires at the top feed down into the bottom to facilitate the give and take of blood between the upper and lower chambers. 

There's one particular area in your right atrium (the upper right chamber of the heart), called the sinoatrial node, and that node can be thought of as your heart's natural pacemaker. You might have heard of pacemakers before, as many people have artificial pacemakers put in to help regulate their heartbeats. The sinoatrial node is the natural one that your body already has. And if it's working well, the electrical signal goes out, the wiring takes that conduction down and causes that nice synchronous beat to provide blood throughout your body. 

When that sinoatrial node stops working or starts to break down, that can change the coordination of the heartbeats. When atrial fibrillation occurs, the sinoatrial node stops causing a consistent, regular contraction of the heart, and it starts to cause more of a fibrillation — a quivering, or irregular heartbeat. That means it's not really squeezing and contracting the way it's supposed to, it's just kind of vibrating irregularly. Then the beats that are getting down into the lower chambers, the ventricles, start getting really irregular as well. It's like your electrical wiring system has gone haywire and it's sending signals the wrong way. 

So, essentially atrial fibrillation is when the body’s pacemaker stops working. The electricity goes haywire, and your heart’s not beating the way it's supposed to. That causes problems when circulating blood throughout your body because when your upper chambers don't feed blood with a good squeeze into your lower chambers, then they don't fill up as well, and then they can't pump out as much blood. So, what happens? You start to experience symptoms related to inappropriate amounts of blood flow. 

Symptoms of Atrial Fibrillation

Let's talk about what symptoms you might have so that if you're experiencing any of these, you can seek attention from your doctor. 

There are two main categories of symptoms from atrial fibrillation. Naturally, one category is irregular heartbeats. You may feel that flutter in your chest, and your heartbeat may not feel right. However, people often don’t really notice this unless they're actively feeling for their pulse or measuring their heartbeats. That leads us to the second category of symptoms, which has to do with low oxygenation or really low blood circulation. If your heart is not beating regularly, and you're not getting the appropriate amount of blood squeezed out every time to get your lungs (where it is oxygenated and then goes to the rest of your body to feed your muscles, your brain, and everything else) then you might start to feel a little bit fatigued or lightheaded. Maybe if you're trying to exercise, you start to feel you don’t have power in your step, you feel short of breath, or you feel like you might pass out. All of these things are symptoms of having poor circulation, in this case, because your heart isn't beating the way it's supposed to. 

Risks Associated with Atrial Fibrillation

When you aren’t getting enough blood circulating throughout your body as a result of atrial fibrillation, that introduces some risks such as:

  • Risk of passing out and hurting yourself
  • Risk of heart attack
  • Risk of injury to some of your organs that aren't getting the appropriate amount of blood to them.

So, those are some possible issues with arrhythmia. But there's another risk that's even potentially more serious, and that is the risk of stroke and pulmonary embolus. 

A stroke is basically a clot that causes a blockage of blood flow to the brain. A pulmonary embolus is essentially a stroke that occurs in the lungs. It's a clot that stops the blood flow to your lungs, which can be fatal. 

So, why do we get these clots? Well, when the heart is not beating right in that upper chamber, when it’s not squeezing properly, blood starts to pool in there. When blood pools in there and stagnates, it can start to clot just as it would in any part of the body where blood isn’t circulating well. And those clots can grow and then eventually slip out and then get pumped by the lower ventricles into your body where they cause those serious blockages. This is why if you or someone you know has atrial fibrillation, you might be prescribed a blood thinner to prevent those clots from happening. Those are designed to prevent the very serious risks of stroke and pulmonary embolus. 

Preventing Atrial Fibrillation

The good news is that many of the things that lead to atrial fibrillation are completely preventable. The primary reason that people get atrial fibrillation is damage to the heart; damage to the walls or to the electrical wiring system. One of the main causes for this is high blood pressure. So if you can keep your blood pressure down, you will be doing your body a world of favors. You will be putting less strain on the heart, which will help prevent atrial fibrillation. 

This is true of heart attacks as well. If you have a heart attack, part of the heart basically dies, and this can kill the electrical system there, too. It's almost as if the wires get cut in a particular area, and that can lead to atrial fibrillation as well. Heart attacks are likewise preventable if you are taking good care of yourself and keeping your blood pressure in check. 

Additional issues that can trigger arrhythmias include:

  • Thyroid disease, which includes too much stimulation to the heart
  • Excess alcohol which can be toxic to the heart
  • Excess caffeine which can likewise overstimulate the heart 
  • Sleep apnea, which can put stress on the heart because your oxygen is being cut off while you sleep 

These are all things that can cause this deadly arrhythmia. So, what can you do to prevent atrial fibrillation? There is a component of genetics and we never really have much control over our genetics. But there are lifestyle steps you can take to greatly reduce your risk of arrhythmia, including:

  • Keeping your blood pressure under control
  • Keeping your cholesterol under control 
  • Getting good exercise
  • Getting good sleep
  • Not smoking
  • Not drinking alcohol
  • Eating a healthy, balanced diet

These are all things we have control over, which can go a long way toward preventing arrhythmia. 

Wrap-Up

It’s good to try to familiarize yourself with the symptoms of atrial fibrillation: lightheadedness, feeling like you're going to pass out, chest pain, shortness of breath, a sudden sense of fatigue or weakness, or discernible heart palpitations. If you’re experiencing any of these, go see your doctor. It's very easy for your doctor to listen to your heart to evaluate it and to see if you have this arrhythmia, and then he or she can take the appropriate steps to treat it. Your treatment plan may either convert you back to a normal rhythm or to give you medications that can control the scenario to prevent some of the deadly consequences we listed in this article.

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