By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

MEDICATION CAN PREVENT ATRIAL FIBRILLATION-INDUCED CLOTS

Question: My father was just diagnosed with atrial fibrillation. He said his doctor is not real worried about this and is doing some tests. Dad is a healthy 84 year old. How concerned should I be about this? Will he need a pacemaker?
Answer: Atrial fibrillation (AF) is a heart rhythm disturbance where the top heart chambers, called atria, are stimulated to contract in a shallow, rapid and chaotic manner. This disorder affects more than one million Americans. It is more common the older we get, and about 10 percent of those older than 75 years of age are afflicted with AF.

Usually there are symptoms that lead a person to seek medical attention. Some of the symptoms are shortness of breath, dizziness, palpitations, acute onset of fatigue or a worsening of congestive heart failure. AF is easily diagnosed in the physician’s office with an electrocardiogram (EKG).

There are a whole host of possible causes of AF, and treatment focuses on the specific cause or causes in an individual’s case. Heart problems -- such as congestive heart failure, heart attack, rheumatic heart disease and inflammation of the heart (pericarditis) -- can lead to AF. Other underlying problems that can cause AF include high blood pressure, chronic obstructive pulmonary disease (COPD) and heart surgery, as well as severe illnesses like pneumonia or blood stream infections.

Less frequent causes include high or low thyroid hormone levels and various consumed substances. These can range from toxic substances like cocaine or amphetamines to more commonly used substances like alcohol and caffeine.

Last but not least is something doctors euphemistically call “idiopathic AF.” This is a highfalutin way to say that the cause of a particular case of AF is a complete mystery.

Once AF has been diagnosed, patients are usually started on anti-coagulant drugs -- so-called “blood thinners” -- such as warfarin (Coumadin). Use of this drug is very important because the greatest risk of atrial fibrillation is that the shallow and incomplete heart contractions will not pump all the blood out of the upper chambers of the heart. This “stagnant” blood can accumulate in the heart and begin to clot after just a couple of days. Those clots can travel to the brain and cause strokes. Fortunately, anti-coagulant medication can greatly reduce this risk.

Once the patient is fully anticoagulated, electrical cardioversion is sometimes considered. This is done to “shock” the atria back into a normal rhythm. Depending on the underlying cause and the success of initial treatments, further cardioversion treatments may be indicated. Some people with AF do end up with pacemakers to control their heart rhythm, but only after conservative efforts have failed. In older adults with a normal heart rate and no significant symptoms, medications to control the heart rate and anticoagulants may be adequate therapy.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.