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Symptoms, Diagnosis and Treatments

I was diagnosed with Atrial fibrillation (AF) about 3 months ago, although I have been experiencing symptoms for a few years now. As I often suffer from palpitations, and I’m used to new and often quite scary symptoms appearing, I wrongly ignored my heart problems. When you have a chronic illness like ME/CFS, which throws a myriad of obscure symptoms at you, it’s easy just to assume new symptoms are part of it.

Also, when you are told for years that you are a hypochondriac and ‘it’s all in your head’ you are very reluctant to ask for help from medical professionals. I’ve been told most my life that my physical symptoms are caused by my anxiety, and you get to a point where you believe this. So, rather than seek help immediately, I waited until these new symptoms became unbearable before asking for help. But it’s not worth the risk, please don’t make the same mistake as me.

Even though both my parents also have AF, before my diagnosis I knew very little about the condition. I have since researched a lot about it, so I thought I would write a post about this heart condition. What are the symptoms? How is atrial fibrillation diagnosed? and what are the possible treatments?

What is Atrial Fibrillation?

Atrial fibrillation (AF) is an abnormal heart rhythm that happens when electrical impulses fire off from different places in the atria (the top chambers of the heart) in a disorganised way. This causes the atria to twitch, and is felt as an irregular heartbeat or pulse. Atrial fibrillation is also a major cause of stroke.

In AF, the heart rate is irregular and can sometimes be very fast. In some cases, it can be considerably higher than 100 beats a minute.

This can cause problems including dizziness, shortness of breath and tiredness. You may be aware of noticeable heart palpitations, where your heart feels like it’s pounding, fluttering or beating irregularly, often for a few seconds or, in some cases, a few minutes.   

What are the symptoms?
The most obvious symptom of AF is heart palpitations. As well as an irregular heartbeat, your heart may also beat very fast.

Other symptoms you may experience include:

  • tiredness and being less able to exercise
  • breathlessness
  • feeling faint or lightheaded
  • chest pain
  • The way the heart beats in atrial fibrillation reduces the heart’s performance and efficiency. This can lead to low blood pressure (hypotension) and heart failure.

Sometimes AF does not cause any symptoms and a person who has it is completely unaware that their heart rate is irregular.

What it feels like to experience the symptoms of atrial fibrillation.

I personally experience all of the above symptoms. My heart thumps so hard in my chest I can not only feel it, I can hear it. I feel like I’m constantly in motion. When I’m lying in bed I feel like I’m on a water bed. My chest gets so tight, I have to force myself to breathe. And the dizziness gets so bad I struggle to sit up or walk to the bathroom.

Now, I don’t know how much of this is caused by ME/CFS and how much is atrial fibrillation, but hopefully with treatment for my AF these symptoms will improve.

Because the symptoms mimic anxiety and are similar to a lot of the symptoms I experience with ME/CFS, it was hard for me to pinpoint them as new symptoms triggered by heart problems. This is one of the reasons I hesitated contacting my GP about them.

The combination of these symptoms causes a very “odd” sensation. You know when you are on a roller coaster and you go down a big dip or do a loop, you feel like your stomach drops, your heart goes into your mouth and it takes your breath away – it feels like that all the time. I constantly feel uneasy, it mimics anxiety, that feeling of impending doom in the pit of your stomach.

What causes atrial fibrillation?

The exact cause of atrial fibrillation is unknown, but it’s more common with age and affects certain groups of people more than others.

Atrial fibrillation is common in people with other heart conditions. It’s also associated with other medical conditions, including:

  • An overactive thyroid gland
  • Pneumonia
  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
  • Lung cancer
  • Diabetes
  • Pulmonary embolism

I have no idea what caused my AF as I don’t fit into any of the above categories. I believe the symptoms started after a neck injury a few years ago, but I don’t know this for sure. However, the fact that both my parents have AF puts me at greater risk.

What can trigger an episode of atrial fibrillation?

Although I don’t know the cause, I am very aware of what aggravates my symptoms and triggers an episode of atrial fibrillation.

My Triggers:

  • Stress
  • Caffeine
  • Hot and humid weather

Other common triggers include:

  • Drinking excessive amounts of alcohol, particularly binge drinking
  • Being overweight
  • Drinking lots of caffeine, such as tea, coffee or energy drinks
  • Taking illegal drugs, particularly amphetamines or cocaine
  • Smoking

How is atrial fibrillation diagnosed?

I personally had a particularly bad episode which led to a diagnosis. The heart can often go in and out of AF and patients can be aware of these changes. I believe my heart has been doing this for years, but it had always corrected the rhythm by itself. This time, however, this didn’t happen. The longer this episode lasted, the more rapid my heart rate became, and the more severe the other symptoms, like dizziness, palpitations, chest tightness, difficulty breathing, became. After speaking to my GP an ambulance was called. The paramedics carried out an ECG which detected atrial fibrillation. My ECG also showed another abnormality, so I was admitted to hospital.

Monitor your pulse:

The first step in diagnosing AF is for you to monitor your own heart rate. This can be done by firmly place the index and middle finger of your right hand on your left wrist, at the base of the thumb (between the wrist and the tendon attached to the thumb) count the number of beats for 60 seconds. Also note whether you heart beat feels irregular.

I personally have a fitness tracker which monitors my heart rate. This was extremely useful in diagnosing my atrial fibrillation, it also alerted me to the fact something was wrong in addition to my normal symptoms.

Also, monitor any other symptoms you may be experiencing. It’s a good idea to keep a diary of symptoms along with your heart rate which you can present to your GP.

When to see your GP.

If your heart rate is consistently above 100 (particularly if you’re experiencing other symptoms of atrial fibrillation) visit your GP. Also if you are experiencing chest pain, see your GP immediately.

If atrial fibrillation is suspected, your GP may give you an electrocardiogram (ECG) and refer you to a heart specialist (cardiologist) for further tests. An ECG is a test that records your heart’s rhythm and electrical activity and it’s the most common way of diagnosing AF. It’s usually carried out in a hospital or GP surgery, takes about 5 minutes, and is painless.

Additional tests

Once you are referred to a cardiologist further tests may be carried out which may include:

  • an echocardiogram – an ultrasound scan of the heart, which can help identify any other heart-related problems; it’s used to assess the structure and function of the heart and valves
  • a chest X-ray – which can help identify any lung problems that may be causing atrial fibrillation
  • blood tests – which can highlight anaemia, problems with kidney function, or an overactive thyroid gland (hyperthyroidism)

I have had all of the above and I can confirm they are straightforward and (mostly) painless

What treatments are available?

The first step is to try to find if there is a cause of the atrial fibrillation. If a cause can be identified, you may only need treatment for this. For example, if you have an overactive thyroid gland (hyperthyroidism), medication to treat it may also cure atrial fibrillation.

If no underlying cause can be found, the treatment options are:

  • medicines to reduce the risk of a stroke
  • medicines to control atrial fibrillation
  • cardioversion (electric shock treatment)
  • catheter ablation
  • having a pacemaker fitted

A variety of medicines are available to restore normal heart rhythm and control the rate of the heartbeat. Also, due to the way the heart beats in atrial fibrillation means there’s a risk of blood clots forming in the heart chambers. If these enter the bloodstream, they can cause a stroke. Therefore an anticoagulant (blood thinner) is often prescribed.

In my case, a cause was not found. Since my hospital stay 3 months ago, I have been on a blood thinner and a beta blocker. But to be honest, I haven’t noticed much improvement in my AF symptoms, although my heart rate is not quite so rapid.

Cardioversion and other procedures

My cardiologist has recommended I have a procedure called, cardioversion. I have been on the waiting list for this for 3 months now.

Cardioversion involves giving the heart a controlled electric shock to try to restore a normal rhythm. Cardioversion is usually carried out in hospital so that the heart can be carefully monitored.

Other options available if medication and cardioversion are not effective, are:

  • Catheter ablation. A procedure that very carefully destroys the diseased area of your heart and interrupts abnormal electrical circuits
  • Pacemaker. A small battery-operated device that’s implanted in your chest, just below your collarbone. It’s usually used to stop your heart beating too slowly, but in atrial fibrillation it may be used to help your heart beat regularly

Wish me luck!

I’m hoping that after the cardioversion, if it’s successful, I will notice a dramatic decrease in my symptoms, and improvement in my health. I have no idea how much of my fatigue, palpitations and dizziness are actually caused by the AF, and not ME/CFS as I originally thought. Unfortunately success is not guaranteed. My Dad has been through two cardioversion procedure and neither were successful. But I live in hope.

My cardioversion procedure is booked for the 12th of October – wish me luck!

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