How Do You Know if You Have AFib (and what to do about it)

Know the symptoms of AFib to avoid a stroke!

Know the symptoms of AFib to prevent a stroke.

When it comes to heart rhythm issues, AFib (atrial fibrillation) is the most common sustained heart rhythm disorder, causing the heart to beat in a fast, chaotic, and irregular way. Like AFib, AFlutter is also a fast heart rhythm originating in the atria, however the electrical activity is more organized, usually resulting in a regular but rapid heartbeat.

When the atria beat too fast the heart pumps less efficiently, causing blood to pool and increasing the risk of clots and stroke.

What are the symptoms of AFib?

AFlutter and AFib can alternate in the same person and share similar symptoms ranging from none (“asymptomatic”) to severe, including acute shortness of breath and fainting (syncope), the most common being:

  • Heart palpitations (fluttering, racing, or pounding)

  • Fatigue or reduced exercise tolerance

  • Shortness of breath

  • Dizziness or lightheadedness

  • Chest discomfort

  • After treatment, some asymptomatic patients realize that they were more subtly fatigued than they realized when their stamina improves and their exercise capacity increases.

What are the goals of treatment?

Even in very healthy people, stroke prevention is the top priority. The primary goal of treatment is to prevent stroke by controlling the heart rate and restoring normal rhythm.  The step-by-step approach usually starts with the least invasive options and moves to more invasive procedures only if needed.

  1. Lifestyle and risk factor management

  2. Medications

  3. Electrical cardioversion

  4. Catheter ablation

  5. Surgical options 

1)      Lifestyle & risk factor management (least invasive)

Lifestyle changes are foundational and often used alongside other treatments. For many people, especially with early or intermittent AFib, addressing triggers can significantly reduce episodes.

  •  Maintain a healthy weight

  • Treat high blood pressure

  • Manage diabetes

  • Limit alcohol (which can trigger AFib)

  • Prioritize sleep and treat sleep apnea

  • Engage in regular moderate exercise, including strength training

  •   Avoid stimulants (excess caffeine, certain decongestants)

2)      Medications

  • Direct oral anticoagulants (DOACs) are blood thinners for stroke prevention, because blood can pool and clot in the atria. Common options include: Eliquis, Xarelto, Pradaxa and Warfarin (which is an older option requiring monitoring).

  • Rate-control medications to slow the heart rate without necessarily restoring normal rhythm, e.g. low-dose Metoprolol and Diltiazem.

  • Rhythm-control medications, like Flecainide, Amiodarone, and Dofetilide, to restore or maintain normal rhythm.

3)  Electrical Cardioversion (minimally invasive procedure, not involving surgery)

A short, controlled electrical shock is delivered under sedation to reset the heart rhythm.

4) Catheter Ablation (minimally invasive)

Ablation is primarily done to improve symptoms and does NOT eliminate the need for anticoagulation. A thin catheter is inserted through a vein (usually in the groin) and guided into the heart. Abnormal electrical pathways are destroyed using heat (radiofrequency) or cold (cryoablation).

5) Surgical options (such as AV node ablation + pacemaker)

How age and fitness level can impact AFib

Doctors use the chadsvasc score to predict stroke risk in AFib patients, with scores guiding anticoagulation. At age ≥75, you automatically receive 2 points for age and 1 point for being female. A score ≥3 strongly recommends oral anticoagulation to prevent stroke, with higher scores indicating greater stroke risk.

Here’s the empowering part: both AFib and AFlutter are manageable conditions. Early recognition makes a huge difference. If you notice any of these symptoms, don’t brush it off!

  • New irregular pulse  

  • Racing heart without exertion

  • Unusual fatigue 

  • Reduced stamina

  • Episodes of dizziness

Ask for an ECG (electrocardiogram), a simple test to check the heart beat that can clarify what’s happening. Unfortunately, symptoms like fatigue or shortness of breath are sometimes dismissed as “just aging” or menopause, when they may actually signal a rhythm issue. 

AFib is a chronic condition that can be managed with oversight and follow up, monitoring heart rate and symptom development with periodic echocardiograms (echos) to check heart function, blood flow, and structure.

Many healthy older adults live many years – even decades – in permanent AFib with normal heart function, no symptoms, and no decline in lifestyle if the heart rate is controlled. Medications and minimally invasive procedures like cardioversions and ablations can deliver the same results.

 This is the 3rd post of a 3-Part series. For the first two, please see:

AFib: How Lifestyle Supports Healthy Heart Rhythm

Exercise as a Cornerstone of AFib Management

Disclaimer: The information presented in this article should not be construed as medical advice. It is not intended to replace consultation with your physician or healthcare provider.

For expert guidance on strength training techniques, step by step photos depicting how to perform the exercises, and a selection of well-rounded workouts please check out the book Strength Training Exercises for Women by Joan Pagano.

 

 

 

 

 

 

 

 

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