Atrial Fibrillation : Grandfather Of Arrhythmia | Pathology

Introduction

Before start with atrial fibrillation everybody must know the basic things. There are four chambers in our heart. Two ventricles and two atria ( atrium ). All these together beats all the time in order to maintain sufficient blood flow in a particular direction. This is must for supplying oxygenated blood in all parts of body. When there is problem in the speed of heart beat, the supply of oxygen get distracted. The cells starts dying if they don’t get the proper oxygenated blood supply.

General information

Atrial fibrillation is the condition in which atrial rate becomes very high. When we say heart rate of a person is 80 beats per minute. What does it mean ? What is contracting 80 times in one minute ? Is it atria or is it ventricle ? The answer is both. So 80 beats per minute means SA node gives 80 impulses every minute. And all these pass through atrium. Means atrium is contracting 80 times per minute. And all these pass through ventricles. Now ventricles are contracting 80 times per minute. It means every chamber of heart is contracting same times per minute. But in the atrial fibrillation atrial rate becomes 400-500 beats per minute.

Furthermore atrium or ventricles have to contract 400-500 times every minute. One complete beat of heart takes complete contraction and complete relaxation. Now the time is 60 seconds ( 1 min ) and contracting rate is 400-500 times which is truly very hard. Now the contraction and relaxation will be taken place but partially. And this incomplete contraction and relaxation is called as fibrillation. Hence the contractions are ineffective.

atrial fibrillation picture

Now question is if atrium do not contract at all will it be severe condition ? The answer is no because atrium contract to pass the blood to the ventricles. If the atrium don’t contract the blood can reach to the ventricles by the gravity also. But our main purpose to treat the atrial fibrillation is to protect the ventricles from ventricular fibrillation. Because those 400-500 beats will pass to the ventricles. It is very hard for ventricle to pump the blood at this rate.   So in atrial fibrillation our aim is to prevent the ventricular fibrillation. The drugs that we use in treatment of atrial fibrillation decrease the conduction from atrium to the ventricles.

Atrial fibrillation

Heart is the mascular organ in human body which pumps the blood for supplying the oxygen to all parts of body. When it constricts it pumps the blood when it relaxes it gets fill by blood again. The heart has a conduction system where current generation takes place and our heart constrict. The power house of heart is SA node ( sinoatrial node ). Whole story of the atrial fibrillation is based on leaking of electrical activity of the heart that makes the heart irregular to beat.

Atrial fibrillation is considered as grandfather of arrhythmia. Atrial fibrillation means irregular heartbeat. Generally there is a system in our heart that raises a pulse and simultaneously opening of valves takes place. In the atrial fibrillation either the speed of constriction or relaxation of atrium chamber increased or decreased. Due to this symptoms like dizziness, fatigue, increase heartbeat, feeling of relaxation in any part of the body etc. occurs. It is seen in many patients that sometimes the heartbeat becomes irregular but soon it gets back to its normal regularity within 1 week. This is called as the paroxysmal atrial fibrillation. If it goes more than 1 week but upto 1 year it is known as persistent atrial fibrillation if more than  a year then it is said be permanent atrial fibrillation.

Types of atrial fibrillation

On the basis of time period atrial fibrillation is divided into three types which are as follows :

1. Paroxysmal atrial fibrillation – It is seen in many patients that sometimes the heartbeat becomes irregular but soon it gets back to its normal regularity within one week.

2. Persistent atrial fibrillation – If it goes more than one week and patient experiences symptoms with it.

3. Permanent atrial fibrillation – If it goes more than a year and symptoms persist for longer duration, it is said to be permanent atrial fibrillation.

Causes of Atrial fibrillation

  • History of heart disease
  • High blood pressure
  • Diabetes
  • Insomnia ( loss of sleep )
  • Excess alcohol consumption
  • Chronic smoking
  • Athletic conditioning exercises
  • Old age ( ageing )
  • hyperthyroidism
  • Lung disease

Risk factors

Atrial fibrillation occurs when blood flow in the heart get stop. Sometimes it is accumulated in the left chamber of atria. Due to accumulation of thrombosis ( the blood clot ) may develop in the chamber. Now imagine If heart pumps this clot and transfer it to the brain, it may result in stroke. If this clot is pumped by the heart to the other parts of body instead of brain. It may develop lack blood supply or complete stoppage of blood supply to that organ. Hence, muscle paralysis will be occurred. As a result cellular injury will be taken place due to hypoxia ( lack of oxygen to the cells ). Finally cell death (  Necrosis ) will take place.

Underlying deep pathology

All above risk factors increase cause of Stress. Stress on atrial cells leads to tissue heterogenicity. Heterogenicity means atrium cells will aquire different properties i.e, different refractory periods. As a result Ca+ overloaded in the cells and scar formation ( progressive fibrosis ) occurs. So one cell may contract faster as compared to another. In addition to this it will further lead to irregularity and unpredictable movement of impulses.

ecg in atrial fibrillation
changes occur in normal and atrial fibrillation ECG
increased rate in atrial fibrillation
diagram showing comparison between normal and affected atria

Symptoms of atrial fibrillation

Sometimes the symptoms remain hidden while we do screening of the patient. But irregular rhythm still appears. Below is the list of symptoms associated with atrial fibrillation.

  • Chest pain ( Angina )
  • Numbness in any part of the body suddenly
  • Difficulties in understanding and speaking
  • Either unilateral or bilateral weak eyesight
  • Getting fail in balancing the body while moving
  • Severe headache ( migraine )
  • Nervousness

When Atrial fibrillation is most likely to occur

  • Consumption of caffeine
  • Depression and anxiety
  • Insomnia
  • Exercises that make your heartbeat fast

When to consult a doctor

  • When your heart starts beating faster than normal
  • Feeling discomfort around the heart region
  • Tiredness without reason, dizziness or lightheadedness
  • Breathlessness
  • Extreme anxiety

ECG examinations

In an atrial fibrillation patient, the ECG shows the following symptoms when we do electrocardiography of the patient :

  • No – P wave
  • Irregular baseline
  • QRS complex – Normal
  • Irregular R – R distance with every cycle
  • Irregular intervals ~ ( 100-175 bpm )
  • On v1 lead the ECG of atrial fibrillation patient mimics the atrial flutter

Prevention

The doctor will prescribe medicines as per your condition. If he sees any future stroke attack he will suggest medicines that maintain the blood liquidity and inhibits clotting. If you just have rhythmic problem it can be controlled by medicines. But once AFib is detected you can’t be careless for medicines. It may be very very dangerous to stop or start the medicines yourself if you are detected as AFib patient. Always tell your doctor before changing any dose of drug.

  • Cure all mentioned causative diseases
  • Quit from smoking and alcohol consumption
  • Taking heart healthy diet
  • Avoid stress

Do this if Atrial fibrillation is detected

The patients having atrial fib. may undergo critical situation at any stage and anytime. So they need to follow some precautions. The patient had better to wear a medical pendant or keep your medical report card with them all the time. By doing so a medical practitioner will directly get to know that you are a heart patient. Then he will treat in that manner.

Treatment of A.fib

AFib case needs a medical attention and emergency. Treatment varies from blood thinning medicines to anti-rhythmic medicines that maintain the rhythm of heartbeat. Some critical cases need catheter ablation or surgery ( angioplasty ).

anticoagulants

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