Atrial fibrillation and stroke for ASAP Canada

1. Atrial
Fibrilla*on
and
Stroke
Dr.
Sunil
Garg
Cardiologist
ASAP
2014

2. Atrial
Fibrilla*on
• Abnormal
rhythm
of
the
heart
• Very
common
problem
• Over
the
age
of
40
–
one
in
four
chance
of
developing
atrial
fibrilla*on
• More
frequent
in
men
than
in
women

3. Atrial
Fibrilla*on
• Affects
the
atria
or
upper
chambers
of
the
heart
• Electrical
impulses
do
not
properly
circulate
through
the
heart
• Make
your
heart
beat
too
quickly,
too
slowly
or
in
an
uneven
fashion

4. Electricity
of
the
Heart

5. Atrial
Fibrilla*on
• Two
Forms
• IntermiQent
(Paroxysmal)
– Episodes
that
occur
with
varying
frequency
or
last
for
a
variable
period
of
*me
before
spontaneously
stopping
• Chronic
(Persistent)
– Sustained
and
usually
does
not
stop

6. Cause
of
Atrial
Fibrilla*on
• Increases
in
frequency
with
aging
and
typically
occurs
in
people
with
underlying
heart
disease
• Most
common
causes
– Chronic
high
blood
pressure
(hypertensive
heart
disease)
– A
heart
aQack
– Heart
Valve
Disease
(MS
or
MR)
– A
complica*on
of
heart
surgery

7. Atrial
Fibrilla*on
and
Alcohol
• Binge
drinkers
can
usually
develop
atrial
fibrilla*on
that
is
usually
transient
• OWen
occurs
over
weekends
or
holidays
when
alcohol
intake
is
excessive
• “Holiday
Heart
Syndrome”

8. Atrial
Fibrilla*on
and
Hyperthyroidism
• Occurs
in
13
percent
of
people
with
an
overac*ve
thyroid
• Accounts
for
5%
of
all
cases
of
atrial
fibrilla*on
• Make
sure
your
thyroid
levels
are
checked
• Treatable
and
reversible
cause

9. Atrial
Fibrilla*on
due
to
S*mulants
• Drugs
that
s*mulate
the
heart
can
contribute
to
the
development
of
atrial
fibrilla*on
• Caffeine
• Tobacco

10. Atrial
Fibrilla*on
and
Sleep
Apnea
• Condi*on
where
pa*ents
stop
breathing
for
prolonged
periods
while
sleeping
• Overweight
• History
of
Snoring
• Excessive
Sleepiness
during
the
day*me
• Treatment
can
eliminate
atrial
fibrilla*on

11. Atrial
Fibrilla*on
and
Lung
Disease
• Chronic
Lung
Diseases
can
cause
Atrial
Fibrilla*on
• Par*cularly
seen
in
pa*ents
with
emphysema

12. Lone
Atrial
Fibrilla*on
• Some
people
with
atrial
fibrilla*on
have
no
apparent
cause
• Structurally
normal
heart

13. Atrial
Fibrilla*on
Symptoms
• Mild
Symptoms
– Unpleasant
palpita*ons
or
irregularity
of
the
heart
– Mild
chest
discomfort
/
sensa*on
of
*ghtness
– A
sense
of
racing
heart
– Lightheadedness
– Mild
shortness
of
breath
and
fa*gue
that
limit
the
ability
to
exercise

14. Atrial
Fibrilla*on
and
Symptoms
• Severe
Symptoms
– Difficulty
breathing
– Shortness
of
breath
with
exer*on
– Fain*ng
or
near
fain*ng
– Confusion
– Chest
Discomfort
– Fa*gue

15. Atrial
Fibrilla*on
and
Risk
of
Stroke
• Chao*c
rhythm
may
cause
blood
to
pool
in
your
hearts
upper
chambers
• This
leads
to
clot
forma*on

16. Atrial
Fibrilla*on
and
Risk
of
Stroke
• Serious
complica*on
from
Atrial
Fibrilla*on
• Can
lead
to
permanent
brain
damage
• Clot
may
also
travel
to
– Eye
– Kidneys
– Spine
– Important
arteries
in
the
arms
or
legs

17. Risk
Factors
for
Stroke
• CHADS2
– Conges*ve
Heart
Failure
– Hypertension
– Age
(65
to
74
versus
>75)
– Diabetes
– Previous
Stroke
or
TIA

18. Atrial
Fibrilla*on
and
Heart
AQack
• People
who
have
a
heart
aQack
are
at
risk
for
developing
Atrial
Fibrilla*on
• Having
atrial
fibrilla*on
doubles
your
chances
of
having
a
heart
aQack

19. Atrial
Fibrilla*on
and
Heart
Failure
• If
not
controlled,
can
weaken
the
heart
and
lead
to
heart
failure
• Usually
improves
with
treatment
and
control
of
the
heart
rate

20. Atrial
Fibrilla*on
Diagnosis
• Electrocardiogram
• Holter
Monitor
• Event
Recorder
• Echocardiogram

21. Atrial
Fibrilla*on
Treatment
• Short
Term
Treatment
– Rate
Control
– Cardioversion
• Transesophageal
Echocardiogram

22. Atrial
Fibrilla*on
Treatment
• Short
Term
Treatment
– Rate
Control
– Cardioversion
• Transesophageal
Echocardiogram

23. Atrial
Fibrilla*on
Treatment
• Long
Term
Treatment
– Rhythm
Control
• Efforts
to
restore
and
maintain
a
normal
rhythm
are
made
• Can
be
done
via
– Cardioversion
– An*arrhythmic
Drugs
– Abla*on
Procedure

24. Rhythm
Control
• Advantages
– Improved
cardiac
func*on
– Reduced
Symptoms
for
some
people
– Reduced
need
for
medica*ons
• Disadvantages
– High
rate
of
recurrence
of
atrial
fibrilla*on
– Side
effects
of
medica*ons
(AAD)
– Adverse
effects
of
medica*ons

25. Atrial
Fibrilla*on
Treatment
• Long
Term
Treatment
– Rate
Control
• Con*nue
to
have
atrial
fibrilla*on
• Use
medica*on
to
slow
the
heart
rate
down
• Can
be
difficult
to
use
medica*ons
to
slow
the
heart
rate
down

26. Nonpharmacological
Treatment
• Radiofrequency
Abla*on
– Developing
Procedure
– Risk
of
Complica*ons
• Pacemaker
– May
be
needed
for
a
slow
heart
beat
or
to
help
with
medica*ons
• Surgical
Procedures
– Complete
MAZE
Procedure

27. Atrial
Fibrilla*on
and
An*coagula*on
• Increased
risk
of
stroke
as
a
result
of
blood
clots
that
can
form
in
the
heart
• Most
people
are
advised
to
use
a
treatment
to
reduce
the
risk
of
developing
blood
clots
• Most
commonly
used
treatments
include
an*coagulants
or
an*platelet
drugs

28. An*coagulant
Drugs
• Can
reduce
the
risk
of
stroke
by
50
to
70%
– Warfarin
– Dabigatran
(Pradaxa)
– Apixaban
(Eliquis)
– Rivaroxaban
(Xarelto)

29. An*platelet
Drugs
• May
be
used
in
pa*ents
with
lower
risks
• May
be
used
in
pa*ents
who
are
intolerant
to
an*coagulant
drugs
– Increased
bleeding
risk
– Recurrent
falls
• ASA
81
mg
daily
• Clopidogrel
(Plavix)
75
mg
daily

30. What
Can
You
do?
• Monitor
Your
Blood
Pressure
• Control
Your
Diabetes
• Take
your
Medica*ons
/
Blood
Thinners
if
you
have
been
diagnosed
with
Atrial
Fibrilla*on
• See
your
doctor
if
you
develop
the
symptoms
listed

31. Thank
You