Wednesday, August 29, 2012
Several telephone calls over two days went unanswered. Finally, a family friend went over to see what was wrong. When the friend arrived, he found her on the floor between the bed and wall where she had fallen two nights before.
She was awake, but paralyzed on the right side of her body. Despite 80 active years of life, she would never walk or talk again. The diagnosis of a large stroke was not a surprise, but the cause of this stroke was. A heart rhythm problem called atrial fibrillation had allowed a blood clot to form in my grandmother’s heart. This clot then travelled to the brain where it caused the debilitating stroke. Once the clot had done its damage, nothing could be done. Grandma spent the next several years in a nursing home before passing.
I am now a cardiac electrophysiologist, or heart-rhythm doctor, and care for patients with atrial fibrillation every day. Atrial fibrillation is an irregular heart rhythm that affects millions of Americans. It can present with palpitations, shortness of breath or be silent. As in my grandmother’s case, sometimes the first appearance can lead to a stroke. It almost always reduces the quality of life of those that have it. Atrial fibrillation can occur at any age, but it is a lot more common in people over 40.
One of the most important parts of caring for an atrial fibrillation patient is preventing a stroke like the one that struck my grandmother. When atrial fibrillation is present, the heart’s upper chambers, or atria, are quivering. Blood is not effectively moving in and out of the upper chambers, and therefore, clots form in the heart. If the clots migrate to the brain, then stroke occurs. Twenty percent of all strokes are due to this process.
Blood-thinning medicines can effectively protect people with atrial fibrillation from stroke by preventing blood clots from forming in the heart. These medicines need to be used very carefully under close supervision of a doctor, since bleeding is a possible side effect.
Some patients have such an extreme elevation in their heart rate with atrial fibrillation that they need to be hospitalized and placed on medicines to get it under control. While some patients go back into normal rhythm on their own after an atrial fibrillation attack, others may require a therapeutic shock. Strong heart rhythm medicines are sometimes needed to keep patients from going back into atrial fibrillation. When these medicines don’t work, a procedure called catheter ablation will often be effective in controlling atrial fibrillation. Catheter ablation is a form of heart catheterization that can cure atrial fibrillation in some patients.
The most important thing to remember about atrial fibrillation is that it does require medical attention. If you have been identified as having atrial fibrillation and developed symptoms like shortness of breath, palpitations or fatigue, you should get more aggressive therapy earlier. Atrial fibrillation becomes more difficult to treat the longer it has gone untreated.
Roper St. Francis Healthcare
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