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Atrial Fibrillation (AFib): A race to the wrong finish line

By Christina Nowak, MScPT,CSCS, PhD (student)

The heart is a truly miraculous thing and is my second favourite organ (with my first favourite being the brain!). Most of the time we don’t even pay attention to it even though we talk about it all of the time.

We know the heart is central to our culture and understanding of life and emotion when we have sayings like “my heart is breaking”, “my heart goes out to you and your family”, or your heart racing when you see that special someone.

But what happens when something goes wrong? When our heart starts to race not because we’re about ready to give a speech or because we’re exercising but for what seems like no reason?

An irregular change to your heart beat is known as an arrhythmia. This can be a skipped beat or an off pattern. Atrial fibrillation is the most common type of arrhythmia. Atrial fibrillation, often called A-Fib or AF, is a rapid, irregular beating of the heart. Our normal heart rate is 60-100 bpm. In A-Fib, your heart can race up to 350-500 bpm! This can last for over a week! The risk of A-Fib increases with age and so with our aging Canadian population and really aging world population, this is becoming a growing concern. It is estimated that it effects 33.5 million people worldwide and

1 in 10 Canadians over the age of 80 have atrial fibrillation


A-Fib and the Aging Heart: What are the links

As we get older, how well our heart pumps blood starts to go down. Just as we get wear and tear on our muscles, we also accumulate wear and tear on the heart. Fun fact – the heart actually is a muscle so this just makes sense! Exactly what happens is for physiology textbooks, what matters for us is that as we get older there are a couple of key changes that happen that increase our risk for A-Fib such as
• The number of cells that help the heart to beat goes down. This means that        we aren’t as sensitive to the signal for getting our heart to beat to a regular rhythm
• There is more fat around the heart – increases pressure and makes the heart have to work harder
• We aren’t as sensitive to adrenaline. Adrenaline is the signal that we have that tells our heart to speed up because we are doing something that requires more oxygen. Because we aren’t as sensitive, our heart rate doesn’t respond as fast to changes in demand from the body
• Calcium develops in the valves of the heart – again making our heart work harder

For a more science-heavy explanation, check out this link from the Arrhythmia Alliance.

For my clinicians
The decreased sensitivity to adrenaline is related to the decreased sensitivity of the beta-adrenergic stimulation. It is because of this we believe that older adults cannot regulate their heart rate as well when performing exercise and why a gradual warm up and cool down is appropriate.

 

The Symptoms of AFib, how will I know?

How AFib presents is different for different people. For some, they experience zero symptoms! They have no idea that they have A-Fib. For others they can experience common symptoms such as

Common symptoms of A-Fib
• Chest pain
• Extreme tiredness/ fatigue
• Shortness of breath
• Racing heart beat/ pulse
• Feeling anxious
• Light-headedness
• Trouble concentrating

The Heart and Stroke does three in-depth modules (much more information that we have time for here) and you can find them at this link!

Confirming the symptoms and making the diagnosis

A-Fib is confirmed by an electrocardiogram (the ECG they put on your chest that monitors your heart rate), a monitor you wear for 7 days (called a Holter monitor), a blood test or treadmill stress test. Going to your family doctor or cardiologist if you think this may be you is a very important first step!

Why is this important?

A racing heart beat puts a lot of stress on your heart. Persons with A-Fib commonly show up in the emergency room and doctors offices more often because of symptoms. Your risk of stroke also drastically increases when you have A-Fib. It makes you at more risk for heart failure (when your heart isn’t strong enough to meet the demands of your body’s day-to-day activities). All bad things

Another important piece is that it often decreases the quality of your life… you’re more tired and breathless. Not what we want to be doing in our retirement! So treatment is key!

There are multiple methods to help you improve symptoms of A-Fib, first of which is going to your doctor. We will be exploring more of these in upcoming articles. To stay up to date with some of these articles and get access to heart healthy recipes, sign up for the newsletter!

 

For a hint of what’s to come ….

DESSERTS

References: 

Halle, M., Adams, V., Edelmann, F., Pieske, B., & Wisloff, U. (2016). Benefit of exercise in atrial fibrillation: Diastolic function matters! Journal of the American College of Cardiology, 67(10), 1257-1258. doi:10.1016/j.jacc.2015.09.115 [doi]

Keller, K. M., & Howlett, S. E. (2016). Sex differences in the biology and pathology of the aging heart. The Canadian Journal of Cardiology, doi:S0828-282X(16)30007-1 [pii]

Magnani, J. W., Wang, N., Benjamin, E. J., Garcia, M. E., Bauer, D. C., Butler, J., . . . Health, Aging, and Body Composition Study. (2016). Atrial fibrillation and declining physical performance in older adults: The health, aging, and body composition study. Circulation.Arrhythmia and Electrophysiology, 9(5), e003525. doi:10.1161/CIRCEP.115.003525 [doi]

Proietti, M., Boriani, G., Laroche, C., Diemberger, I., Popescu, M. I., Rasmussen, L. H., . . . EORP-AF General Pilot Registry Investigators. (2016). Self-reported physical activity and major adverse events in patients with atrial fibrillation: A report from the EURObservational research programme pilot survey on atrial fibrillation (EORP-AF) general registry.Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology, doi:euw150 [pii]

3 Comments

  1. Joyce Xavier says:

    Thanks for sharing and making us more alert of our health issues.

  2. Atrial fibrillation anda corresponding enlargement of the left atrium may cause an increase in size of the mitral valve annulus.

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