Dr. Anis Ansari is a nephrologist practicing in Clinton, Iowa. Dr. Ansari specializes in the care and treatment of the kidneys. As a nephrologist, Dr. Ansari most typically treats conditions like kidney stones, chronic kidney disease, acute renal failure, polycystuc kidney disease, high blood pressure and more. Nephrologists... more
What is atrial fibrillation?
Atrial fibrillation (AF) is one of the most common cardiac arrhythmia encountered in our practices. It affects 2.2 million people in the United States who are older than 50 years of age. Urgent recognition and intervention are required to prevent its consequences. Failure to treat promptly can lead to stroke, heart attack, and sudden death.
Atrial fibrillation is common problem in cardiac patients. People have a one in four lifetime risk after age forty of having atrial fibrillation. In atrial fibrillation, the patient’s atrium and ventricle are not in sync, therefore causing ineffective contraction of the heart. Atrial fibrillation has clinical importance related to loss of atrial contractility, inappropriately fast ventricle response, and emptying, leading to the risk of clot formation and subsequently a thromboembolic event. The patient will usually complain of palpitation, chest pain or pressure, shortness of breath, and generalized weakness.
The most common causes of atrial fibrillation are coronary artery disease, valvar heart disease, hypertension, diabetes, hyperthyroidism, COPD, pulmonary embolism, and sleep apnea. Caffeine, cigarette smoking, and binge drinking can set off AF.
Risk factors for atrial fibrillation include previous strokes, Tran’s ischemic attack, mitral stenosis, hypertension, and diabetes, age more than 75 and left ventricular dysfunction. The stroke rate of in-patient with cardiovascular disease (CVD) can be 5 to 12 percent.
A patient with new onset atrial fibrillation with rapid ventricular response is admitted to the hospital with a monitored bed. Blood work is then drawn. Cardiac enzymes and an electrocardiogram are done to rule out any heart attack and rhythm abnormalities and chemistries to rule out hyperthyroidism and electrolyte abnormalities. A chest X-ray is also done to rule out congestive heart failure. Patients are started on a blood thinner medication to prevent the occurrence of stroke. An echocardiogram is performed to diagnose functional or valvular abnormalities. A cardiologist is consulted for such procedures as a stress test and cardiac catheterization, if required, or a medication for conversion to normal sinus rhythm.
Mortality rates were high with Cardiovascular Disease, ranging from 19 to 52 percent, which is 5 to 10 times higher than in a person without CVD. Two thirds of stroke events could be averted by anticoagulation with warfarin. The cost of stroke can be enormous since patients may need long term hospital care, skilled nursing facilities, home health care, and frequent follow up appointments with several specialists.
People who have valvular heart disease and end stage renal disease need to be treated with warfarin. In patients with non-valvular heart disease, treatment with warfarin can reduce the risk of stroke by 60 to 70 percent. Atrial fibrillation can be treated with warfarin or pills (Apixaban, Dabigatran, Rivaroxaban). The side effects of these medications will include a risk of gastrointestinal or intracerebral bleeding.
Atrial fibrillation is a serious medical condition that requires prompt treatment. Delay in management of this condition can result in a stroke, heart attack, and sudden death.
Anis Ansari, MD, FASN
Chairman, Department of Medicine
Mercy Medical Center, Clinton, Iowa