Atrial fibrillation means that the heart beats irregularly and often even faster. This means that the heart cannot pump around the blood in the body as efficiently as it usually does. Permanent atrial fibrillation is the most common cause of stroke. This is because the flicker degrades blood circulation in the atrium of the heart, making blood clots more easily formed.

In the case of permanent atrial fibrillation, the flicker does not pass, unlike the attack atrial fibrillation which usually passes by itself. Most people with permanent atrial fibrillation need to use drugs.

Symptoms of permanent atrial fibrillation

These are the most common symptoms of atrial fibrillation:

  • Palpitation.
  • Irregular heart rate.
  • Impaired physical strength.
  • Hard to breathe.

The heart pumps blood worse, so-called heart failure gives different symptoms. You may have poorer workability, shortness of breath and swollen bones. Sometimes you may also have symptoms of permanent atrial fibrillation such as angina in the chest. You can also have atrial fibrillation without any symptoms at all. The flicker is then often detected when you seek medical attention for other problems. 

When should I seek care?

If you suspect that you have atrial fibrillation, you can contact a health care center. 

You can seek care at any healthcare center you want throughout the country. You also have the opportunity to have a regular doctor’s contact at the health center. 

If you have previously been diagnosed with permanent atrial fibrillation, you should seek medical advice if one of the following happens: 

  • You gain weight without natural explanation or get swollen legs.
  • You have a higher heart rate than usual at rest or during physical exertion.
  • You have difficulty breathing or getting chest pain.

Seek medical care directly at a health center or emergency room if the complications come suddenly and feel clear. If the inconvenience is not so noticeable or develops over several days or weeks, you should contact your doctor to get back to your doctor as soon as possible.

Investigations

Your doctor will ask you questions about your lifestyle. This applies in particular to smoking, snuff, alcohol use, coffee habits and exercise. They also want to know if you have other problems that may be related to heart disease and vascular disease.

After ECG, diagnosis is made

The diagnosis of atrial fibrillation puts the doctor through a regular ECG examination. It works so that you get special plates, so-called electrodes, attached to the chest and to the arms and legs. The plates allow the electrical activity of the heart muscle to be measured.

Other investigations 

The doctor does a general body examination to make sure you have no other heart disease, lung disease or stomach, and intestinal disorders. With a stethoscope, the doctor can hear if there is any bleeding noise from the heart valves. Blood pressure is also measured.

Laboratory samples are taken to investigate the renal function and salt balance. The study also shows if you have anemia, diabetes or thyroid function.

An ultrasound examination of the heart is done to assess how the heart muscle and heart valves work.

Some people may need to go through a larger investigation to be able to get the right diagnosis and treatment. This includes examinations such as long-term ECG or work tests. Long-term ECG means that you have cables glued to the chest for 24 hours to record the activity of the heart. The cables are connected to a small portable recording device, which you can take home with you. In this way, a longer period of time with a recording of the heart rhythm can be analyzed afterward. A work test is an ECG examination that is performed at the same time as you exert yourself, for example by cycling on a test cycle. 

When the investigations are ready

After the examinations are complete, you will get information from the doctor if the atrial fibrillation is caused by another heart disease or if it is due to some other disease. You also go through the effects of atrial fibrillation on the body, especially the risks of heart failure and blood clots. Then you talk about the advantages and disadvantages of all the different types of treatments for permanent atrial fibrillation available.

You have the right to understand

In order for you to be able to participate in your care and make decisions, it is important that you understand the information you receive from the healthcare staff.

Treatment for permanent atrial fibrillation

You will receive different types of treatment for permanent atrial fibrillation depending on how severe you have and how long you have had them. Most people who have permanent atrial fibrillation need to use drugs, often life-long. Among other things, it is blood thinners, which reduce the risk of blood clots.

In consultation with your doctor, you will decide which form of blood-thinning treatment is best. There are some individuals who cannot get blood thinners because they get bleeding much easier than others.

If you have a lot of trouble with your atrial fibrillation but have only had it for a short time, you will often receive electrical treatment, called electricity conversion. This means that you are asleep and receive an electric shock through the chest. The purpose of the electrical treatment for permanent atrial fibrillation is to restore the normal rhythm of the heart. When the atrial fibrillation has been around for more than a year, it is often very difficult to restore heart rhythm. If you have had atrial fibrillation for a long time or if you do not have that much trouble, you can instead get medicines that slow down the too fast heartbeat.

You may also not feel your atrial fibrillation at all. Then you may not need any medication, in addition to any blood thinners. 

Two treatment paths

When you have permanent atrial fibrillation, you can get two different types of treatments:

  • Treatment that involves restoring the heart rhythm and preventing atrial fibrillation from recurring.
  • Treatment which means that you have left the atrial flicker itself, but that the problems are alleviated with medication. It is a drug that slows the heart down so that it does not beat as quickly, which also strengthens the heart muscle.

If you have trouble with the atrial fibrillation, it is usually relevant to try to restore your heart rhythm. Both treatments usually require treatment with blood thinners to reduce the risk of blood clots.

When the heart rhythm should be restored

The heart rhythm can be restored with an electrical conversion. It is a treatment that means you get anesthetized and get an electric shock through the chest. You can also get the right heartbeat again with the help of drugs. Electric shock is the most effective method and means that most people with chronic atrial fibrillation regain their normal heart rhythm, at least for a while.

Electric shock treatment

Above all, treatment with electric shock is given to people who have a lot of trouble and where the atrial fibrillation has not lasted for so long. It is a good and reliable treatment method that has been used for a long time.

First, you may need to prepare for drug treatment. This is true if you have had atrial fibrillation for more than two days, as blood clots may then have started to form in the atrium of the heart. To reduce the risk of blood clots, take blood thinners for at least three weeks before the electrical treatment and at least four weeks after.

When it’s time for the electric shock treatment itself, you can come to the hospital, but you can go home again the same day. First, you are sedated with an anesthetic drug that is given in syringe. Then you get an electric shock through the chest. Often the heart rhythm then returns to a normal rhythm. After the electric shock, you may feel it burning, or burning in your skin. It goes away after a couple of days. 

One problem is that many can regain their atrial fibrillation. Repeated electric shocks may then be necessary. Between one-third and one-half of the people treated to receive the flickering back within three months. After one year, the number of relapses has increased further.

Electric shock best for short atrial fibrillation

The treatment with electric shock is most effective if you have had atrial fibrillation a short time before the treatment. It is rarely meaningful to receive electric shock treatment if you have had atrial fibrillation for more than a year.

If the atrial fibrillation comes back, you may receive repeated treatments with an electric shock while taking medicines that stabilize the heart rhythm. If you get despite this new relapse, it is doubtful whether you have the benefit of continuing with the electricity treatments.

Treatment with medicines for the right heart rhythm 

As an alternative to electric shocks, you can get medicines that restore the heart’s rhythm. The advantage of this is that you do not have to sleep. The disadvantage is that it is not as often possible to regain the usual heartbeat. In addition, you may get side effects from the drugs. Just as with electric shock therapy, preparatory treatment with blood thinners is needed.

What happens in the body

Atrial fibrillation means that the heart beats with an irregular rhythm. You also usually get a faster heart rate. This means that the heart cannot pump blood around the body as efficiently as it usually does. The fact that the atrial fibrillation is chronic means that the problems persist.

The risk of permanent atrial fibrillation increases the older you get, but before the age of 50, the disease is uncommon. The causes are only partially known. There is a connection with other cardiovascular diseases. If you have diabetes or hyperthyroidism, also called venom trauma, you also increase the risk of permanent atrial fibrillation.

You can also have atrial fibrillation that comes in attacks. Then the trouble often goes away by itself.

A muscle that is constantly working

The heart is a muscle that pumps blood around the body so that all organs get their vital oxygen. The heart consists of two atoms and two chambers. Between the atrium and chamber of the heart and at the exit from the chambers are heart valves. The heart valves act as check valves, which prevent the blood from flowing back as the atrium or ventricles contract.

Blood that has released oxygen into the body returns to the right atrium of the heart. The atrium contracted and the blood then flows into the right ventricle. The chamber in turn contracts and sends the blood into the lungs for oxygenation again. The oxygenated blood then flows from the lungs to the left atrium of the heart and left ventricle and then via the large body pulmonary artery into the body. The blood then has a high pressure to reach all parts of the body and release oxygen. Then the blood flows back to the right heart half again in a continuous cycle.

The pulse shows the beat

Each contraction of the left ventricle increases blood pressure. You can feel your heart rate beating the various arteries, the arteries. Most often, the heart rate is between 60 and 90 beats per minute when you do not exert yourself. That means almost 100,000 strokes per day.

The heart is controlled by electrical signals

The heart’s rhythm is controlled by electrical impulses from the so-called sinus node in the right atrium. It provides a regular rhythm for the contraction of the heart muscle. From the sinus node, the signals are first spread to both atoms of the heart, which contract and compress the blood into the chambers. The signals then pass into the heart’s electrical system, the so-called rectilinear system, to the chambers that are in turn to contract.

It is important that the atrium and the chambers contract in turn because then the heart is filled properly and every heartbeat benefits as much as possible. If the normal cardiac conduction system works poorly or completely ceases to function, other parts of the heart muscle cells can enter instead and form electrical signals that take over the control of the heart’s rhythm. But such a rhythm makes the heart pump out blood less efficiently.

Atrial fibrillation interferes with the heart’s work

In atrial fibrillation, the heart’s signaling system has partially disrupted. The atrial electrical signal is then not started from the sinus node. Instead, electrical signals occur in several places in the atrium without coordination. This electrical disorder results in the atrium contracting independently of the chambers, moreover, very quickly, often more than 300 times per minute. The atrium can neither be filled with nor effectively drained of blood between contractions. Only some signals from the atrium are transmitted to the chambers. Therefore, the contractions of the chambers, and thus the pulse, become irregular and often faster than usual. The effect of poor coordination between the atrium and ventricle, irregular rhythm and rapid heart rate causes the heart to have a poorer ability to pump around the blood, one of the reasons for so-called heart failure.

Common illness in the elderly

Atrial fibrillation is the most common form of arrhythmia in the heart of adults. The disease is unusual in people under 50 years of age. The risk increases with increasing age and every tenth person over the age of 80 has atrial fibrillation.

Relation to other diseases

The causes of atrial fibrillation are only partially known. More than six out of ten people with atrial fibrillation have some other cardiovascular disease, such as high blood pressure, heart valve disease, heart failure or heart muscle inflammation. The risk of atrial fibrillation increases if you have diabetes or hyperthyroidism, also known as venous trauma. But just over three in ten people with atrial fibrillation have no heart disease or another underlying disease.

So you can reduce the risk of flicker

By quitting smoking, starting to eat less high-fat foods and exercising more, you reduce the risk of getting cardiovascular disease, which in turn can reduce the risk of atrial fibrillation. But if you’ve got permanent atrial fibrillation, you can’t change it by changing your lifestyle.

Atrial fibrillation increases the risk of blood clots

Permanent atrial fibrillation is the most common cause of blood clots in the brain and thus stroke. The increased risk of blood clots is due to the blood flowing worse and sometimes standing still at the heart’s atrium. The blood will then be easier to clump. If you have atrial fibrillation, you can often reduce the risk of having a stroke by taking blood clots. It is the doctor who must decide if you can take such medication

The patient pad on atrial fibrillation

Here you can hear patients and healthcare professionals talk about atrial fibrillation.

Ehtisham Nadeem

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