Guest Blog – Atrail Fibrillation Association
Diagnosing & Treating AF (part 2 of 3 guest blogs about AF)
The simplest way to detect AF is to feel a pulse. If the rhythm of the beat seems irregular, this may indicate AF. However it is very important to check this with a doctor and to find out whether you do actually have AF. If a clinician suspects you have Atrial Fibrillation, they will arrange for you to have an ECG (electrocardiogram). An ECG is painless and records the electrical activity of your heart. Usually this is carried out in a GP surgery or at a local hospital, however, if your episodes ‘come and go’, you may be given a monitor – this is worn (simply taped to your chest) for 24 hours or more, and continuously records the electrical activities of your heart.
When the monitor is returned the clinician can download the information and assess it. The heart rhythm can be diagnosed with certainty and possible underlying heart problems may often be detected.
Following the ECG, and if you are diagnosed as having Atrial Fibrillation, you may need to have an echocardiogram (a scan) which can assess the structure and overall function of the heart. This test is painless and without any risk to a patient. The results from this test will tell the physician about heart muscle disease (thickening or thinning), the size of the main pumping chambers, and the state of the heart valves, any of which might have aggravated the heart rhythm abnormality.
A variety of blood tests may be needed, depending on the individual’s medical history. In almost all cases, the activity of the thyroid gland will be measured through a blood sample, because over activity may provoke AF.
Free, medically approved and endorsed patient information can be ordered or down loaded from Atrial Fibrillation Association
If a patient has suffered chest pain, a marker of heart muscle damage (troponin) is often measured. If a patient is taking any other medication or has underlying heart disease or has any other medical problems, suitable tests will also be carried out.
Once Atrial Fibrillation has been diagnosed, there are a number of treatments available. The mainstay of treatment of AF is with drug therapies. Other non-drug therapies such as pacemakers and ablation therapies are reserved for certain subsets of AF patients. The drugs used to restore the normal heart rhythm are known as anti-arrhythmic drugs. They work by blocking specific channels in the cardiac cell. Anti-arrhythmic drugs comprise different drug classes and have different modes of action. Moreover, someclasses and even certain drugs within a class are effective for particular rhythm disturbances. Some drugs, aim for Rhythm Control, that is, to restore and maintain normal rhythm but can have troublesome side-effects.
Another type of drug such as beta-blockers aim for Rate Control. This means slowing the irregular heart rate without attempting to restore the normal heart rhythm. Rate control is not inferior to rhythm control and is an attractive alternative in patients with a high risk of AF recurrence. In less active patients, other rate control drugs, such as digoxin can be used. Combinations of digoxin and beta blockers or calcium antagonists may be required to achieve effective rate control. Amiodarone is often used for rate control in AF when its rhythm control efficacy has been exhausted. However, given its significant side effect profile, it is not routinely used for rate control.
Unfortunately, there is no “one size fits all” answer to the management of AF. Multiple drugs may be tried and adjusted until one is found that achieves the desired goal of optimal rate or rhythm control with minimal side effects.
Recently several new drugs have been approved for use with AF. One, Pradaxa, also known as Dabigatran, prevents blood clots which cause stroke, which is a risk for people with AF. There are also surgical interventions for AF such as Catheter Ablation and Cardioversion. Cardioversion is suitable for those recently diagnosed while Ablation is reserved for those with intrusive symptoms that impact significantly on quality of life, are refractory to treatment with medication or where medical therapy is contraindicated because of other conditions or intolerance.
Get back in Rhythm with Barry Manilow
We thought you may like this piece of information as a great number of Heart Failure patients experience Atrial Fibrillation (Afib) or other Heart Rhythm complications. The site is great and really helps with self management of the condition. Just goes to show you are not alone!
Music iconBarry Manilow today revealed his long struggle to manage atrial fibrillation (AFib). He has joined with Sanofi-Avensis the Pharma company that has anti-arrhythmic drugs like Amiodarone and Dronedarone in it’s stable is to kick-off Get Back in Rhythm ™ , a US education campaign to raise awareness about Atrial Fibrillation, and to encourage people to learn more about all the risks of AFib and the importance of keeping the heart in rhythm.
Manilow says “When I first experienced AFib more than 15 years ago, it was really scary, it felt like a fish flopping around in my chest,” said Manilow. “I thought I knew about all the risks, but it turns out I didn’t, so I was really lucky I had such great doctors helping me manage it from the start.”
Atrial Fibrillation is a complex condition and many patients may not recognise the symptoms or the full range of health risks associated with it. This is why Manilow encourages those affected by AFib to visit www.GetBackInRhythm.com, to test their AFib knowledge with the Rhythm IQ quiz, learn more about all the risks of the disease and print a guide. The campaign will also include a public service announcement featuring Manilow to help raise awareness about AFib.
Manilow continues “At first, I kept my AFib private because I didn’t want to acknowledge there was something wrong with my heart. But now I realise a lot of my fans and so many others could be affected, so I want to do all I can to help them take it seriously, understand all the risks of AFib and seek the best care,” admits Manilow. “The bottom line is AFib needs more awareness. Patients need more education. No one should settle for a life out of rhythm.”
The goal of Get Back in Rhythm is to improve the health and well-being of those affected by Atrial Fibrillation. The campaign encourages people to learn more about all the risks of Atrial Fibrillation, and talk with their healthcare provider about how to maintain a normal heart rhythm and manage the disease. wwwGetBackInRhythm.com offers a collection of resources including the Rhythm IQ to test Atrial Fibrillation knowledge, an Atrial Fibrillation Risk Assessment tool and a discussion guide to help patients make the most of their visits with their healthcare providers. In addition, visitors can learn about Atrial Fibrillation patient and singer/songwriter Barry Manilow’s personal experience living with Atrial Fibrillation and see what he’s doing to help others “get back into rhythm.”
It is worthwhile noting that whilst in the UK celebrity endorsed prescriptive pharma products are not allowed however across the rest of the world there are a lot of countries where celebrities endorse prescriptive drugs and Barry Manilow has supported Sanofi-Aventis which produces Droneadorone (Multaq) which has led to the creation of the Rhythm site which is fuly funded by Sanofi-Aventis.
Pumping Marvellous has no bias and no masters so therefore an alternative opinion is provided here
Cardioversion here we come
Just had my initial consultation with Angela Graves my Heart Failure Nurse and Dr John McDonald my cardio consultant who has just set the date for for my Cardioversion.
Can’t say I am completely looking forward to it, I still have an aversion to needles when I have my general anaesthetic but I realise that it could take me out of AF and back into Sinus Rhythm so I suppose this is a really good thing. The only big decision I had to make was taking Amiodarone.
Amiodarone is an Anti-Arrhythmic drug that has some quite perturbing side effects and I will let you investigate that. It has a half life of 45 days which means in layman’s terms it doesn’t get into your body for 45 days and therefore takes a long time to exit as well. Therefore John McDonald and I have agreed that I start off on 200mg of Amiodarone and continue this until I get my Cardioversion on the 25th November, if I don’t make it into to Sinus Rhythm and stay in AF then I will come off Amiodarone or if I go into Sinus Rhythm then I stay on Amiodarone for 90 days and no more. This is to enable my heart to have the best possible chance of staying in Sinus Rhythm. The reason for taking the Amiodarone before Cardioversion is that it increases the chances by 15-20% of the heart going into sinus rhythm from an electrical Cardioversion. It then keeps the heart stable by trying to prevent a flip over to AF again.
What I will stress is that to have these levels of discussion you need to have the right relationship with your Consultant and Nurse. Both John and Angela are very supportive but probably think I ask too many questions. Because I challenge my clinicians I am an expert patient – you should try it.
So what do the Doctors mean when they talk about Heart Rhythms
What is a normal heart rhythm?
The heart is a muscle that pumps blood around the body. It needs an electrical supply. This is provided by a special group of heart cells called the sinus node, which is also known as your heart’s natural pacemaker.
The electrical signal produced by the sinus node makes your heart’s top chambers or atria contract and push blood through to the lower chambers or ventricles. When the impulses reach the ventricles, they contract to push the blood out of the heart and into the lungs and the rest of the body. These electrical impulses cause your heart to beat between 60 to 100 beats per minute (bpm).
The normal electrical pattern of your heart, is known as sinus rhythm, and can be recorded doing an electrocardiogram (ECG). You can measure your own heart rate and feel your rhythm by taking your pulse.
It’s normal for your heart to beat at different rates during the day. For example it will be slower when you are sleeping, resting or doing activites that do not require a lot of effort but may be faster when you are physically active such as when you are gardening, walking briskly, or running. Your heart rate might also be faster if you are anxious or excited.
So what is a Pacemaker?
If you have a problem with the way the normal electrical impulses in your heart work, you may need to have a pacemaker fitted. A pacemaker artificially takes over the role of the heart’s natural pacemaker (the sino atrial node), either all of the time, or just when your heart is not beating properly. There are several different types of pacemaker. The best one for you will depend on what type of heart rhythm or beat problem you have.
The pacemaker will be implanted in your chest by a surgeon, normally under local anaesthetic, but you will usually need to stay in hospital overnight to check that it is working properly. Serious complications from pacemakers are unusual.
Pacemakers need to be checked regularly by specialist technicians at a pacemaker clinic. You will also need to be careful about things that can affect how your pacemaker works, such as hospital equipment and security systems in shops or at airports.