Every week, I see at least one or two patients in the hospital who have had a terrible stroke that can be linked to inadequate treatment of atrial fibrillation (AFib). As a physician, this is frustrating to me, because it’s very likely these strokes could have been prevented with the proper treatment of the AFib.
I hear a lot of reasons why it’s not treated. To be blunt, the reasons are generally nonsense.
Let me back up a bit. AFib is a condition that causes an irregular heartbeat. Often, the condition has no symptoms, but sometimes patients experience heart palpitations – a racing heart or what is sometimes described as a heart flutter. This can last a few seconds, or it can be more chronic, lasting longer and with increased frequency.
AFib can be associated with high blood pressure, coronary artery disease, diabetes, as well as a number of other medical conditions. It also tends to occur more commonly in older people.
With untreated AFib, blood flow in the top part of the heart (known as the atria) slows down. Sometimes, the slow blood forms a clot that can leave the heart and travel throughout the body. This is known in medical terms as an embolic event. When one of these clots reaches the brain, it can block a blood vessel and cause a stroke. The size and severity of the stroke depends on the size and location of the blocked brain vessel.
Preventing stroke caused by AFib
People with AFib are five times more likely to have a stroke than those without it. Patients who have AFib caused by heart valve disease are at the highest risk of having a stroke.
If you’ve been diagnosed with AFib, your physician will ask questions about your health and perform a physical exam to determine your risk for stroke. An ultrasound of the heart, known as an echocardiogram, will help identify if you have valvular heart disease.
Several exciting new treatments are available to reduce the risk of having a stroke due to AFib. This includes a new array of anticoagulants, or blood thinners. These drugs, which you might notice are heavily advertised on television, reduce the likelihood of strokes. This reduced risk of having a stroke is likely due to reduced formation of clots in the heart.
Also, these new medications appear to be safer than warfarin, an older medicine used for the same reasons. Other advantages to the new medications include:
- Reduced incidence of bleeding into the brain, as compared to warfarin.
- Regular blood monitoring is not necessary. (By comparison, monitoring is required when taking Warfarin.)
- Few interactions with food or other medications. (Warfarin interacts with many types of food and other medications.)
What can you do?
First of all, if you’ve been diagnosed with AFib, talk with your doctor about your health, your risk of having a stroke, and options to decrease your chances of having one. If it’s determined that a blood thinner is right for you, please take your medication as prescribed, unless you talk to your physician and he or she recommends you should stop taking them. Remember, the medications, often referred to as NOACs, are safe and they’ve been evaluated and approved by the FDA.
While all drugs carry some element of risk, I am very comfortable as a physician when I prescribe the NOACs. Their benefits and safety have been proven in several large clinical studies.
If you think you might have AFib, an irregular heartbeat sometimes accompanied by chest pain or dizziness, consult your primary care physician. Your physician will conduct an EKG, a test that monitors heart rhythm.
If an irregularity is found, you will likely be referred to a cardiologist. From there, you and the cardiologist can discuss the best treatment plan for you. That treatment might or might not include going on anticoagulant medications. Other medicines might also be used to control your irregular heartbeat.
No matter your situation, when you see your physician, arm yourself with information. Don’t be afraid to ask questions. Find out what type of AFib you have and how you can manage it. Make your treatment a collaboration between you and your physicians. Most of all, don’t stop taking the medications, unless you talk with your physician first.