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Are You Fibbin?

I can’t tell you what the statistics are on how many people lie or fib, but I can tell you that over 4% of people over the age of 60 today have Atrial Fibrillation or AFib. Since September is National Atrial Fibrillation Awareness month, I thought I’d shed some light on this increasingly common heart condition and what can be done about it.

AFib is an electrical disturbance that effects the top chambers of the heart called atria. In AFib, that steady, rhythmic, beating of the heart or lub-dub as the “professionals” call it, becomes erratic and disconnected from the faithful pacemaker of the heart, the sinus node. This causes an irregular and much less efficient beating of the heart that sounds more like an old washing machine during a power failure – ker chunk . . . . . . ker chunk . . ker chunk.

You may not even be aware that you have AFib, or, you may have a sensation that your heart is pounding or fluttering – like fish flopping around in your chest. You might feel dizzy or lightheaded, you might faint or feel nauseous. Fatigue is a common complaint among people with AFib.

AFib may last a lifetime or a just a few moments. You could go in and out of it - a condition called Paroxysmal AFib (starts and stops). Is it dangerous? Well, that depends on how the ventricles respond. The ventricles are the lower chambers of the heart that are responsible for pumping the blood. Since our heart rate is determined by how many times per minute these chambers squeeze the blood out, if the ventricular response is too fast, you could be in a lot of trouble. If AFib causes your heart to beat dangerously fast, there are medicines in the class of beta blockers or calcium channel blockers that work well to slow it down but because the nature of AFib is an irregular rhythm, these can also make the heart beat too slowly creating dangerous pauses that can temporarily stop the flow of blood altogether.

Another potential danger of AFib is the risk for blood to pool in the upper chamber due to the inefficient emptying of blood into the ventricle below. If blood pools, it can coagulate and form a clot which can be transported to the brain and cause a stroke. If your AFib is the type that puts you at high risk for stroke, the doctor will prescribe anticoagulants or blood thinners. Coumadin or Warfarin have been the standard anticoagulants used to treat the risk of stroke in AFib but these drugs must be carefully monitored to be sure they thin the blood enough to prevent clots from forming but not so thin that they cause internal bleeding. This means you have to have frequent lab tests to make sure the dosage is right – especially at the beginning of therapy. Some people find having their blood drawn every week or two is inconvenient but, I would think, having a stroke is about as inconvenient a thing as you could get. Lately, I’m seeing another anticoagulant called Eliquis used in patients with AFib which provides therapeutic blood thinning without the need for lab tests. Your doctor will determine which drug is best for you.

People that are on blood thinners must be careful of the risk for excessive bleeding. Try to avoid activities such as using sharp tools like table saws or chisels (this is not the time to take up woodworking or knife throwing). You may have to give up sports that involve getting your head knocked around like football or rugby – many heads running and falling together have this potential – skiing, snowboarding, or any sport that requires wearing a helmet or has the word “extreme” attached to it should be avoided. If you do hit your head while on blood thinners, call your doctor right away because even the tiniest bleed inside your brain gone undetected could lead to devastating consequences. The only way to be sure you’re not in danger is to get your head scanned.

It’s hard to say what causes AFib but it usually has something to do with damage to the heart muscle that effects the electrical pathways of the heart. This can be due to a heart attack, complication after heart surgery, high blood pressure, diabetes, obstructive sleep apnea, hyperthyroid disease, cerebrovascular disease, COPD, or unsafe alcohol use. Conditions that stretch the heart muscle as in heart failure, or an enlarged heart can also cause AFib. In some cases, if it’s possible to reverse the condition causing the AFib you may be able to stop it.

Diagnosing AFib is simple – all it takes is an EKG. It is such a common and detectable arrythmia that you might even get a diagnosis on one of those wristwatch cell phones that people wear today. I’m not fibbin - if you suspect you could be one of the 5 million Americans with AFib, call your doctor. There are many treatment options available that range from oral medicines for rate control and risk reduction, to minimally invasive, low risk surgical procedures that are very effective at either controlling or eliminating AFib altogether. Remember, even though you may not feel bad, AFib can be very dangerous, so get it checked out and taken care of right away.

For more on AFib see the Heart Rhythm Society website at or Mayo Clinic

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