A Simple Guide to Atrial Fibrillation I

A Simple Guide to Atrial Fibrillation I
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What is Atrial Fibrillation?
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Atrial Fibrillation is a heart condition where the disordered electrical impulses of the atrial muscle leads to irregular electrical impulses to the ventricular heart muscles resulting in irregular heart beats.


Who is at risk of Atrial Fibrillation?
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1.Age: 8% of people over 80 has AF

2.family history of AF increases risk by 30%.

What is the cause of Atrial Fibrillation?
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Atrial Fibrillation is caused by underlying heart conditions such as:

1.Primary heart diseases:

a.coronary artery disease

b.mitral stenosis

c.mitral regurgitation

d.hypertrophic cardiomyopathy

e.pericarditis

f.congenital heart disease

g.previous heart surgery

2.Hypertension (High blood pressure)

3.Lung diseases such as

a.pneumonia,

b.lung cancer,

c.pulmonary embolism,

d.sarcoidosis

4.Excessive alcohol consumption

5.Hyperthyroidism


What are the Symptoms of Atrial Fibrillation?
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Atrial fibrillation often do not present with symptoms.

When they do the symptoms are generally non -life threatening:

Symptoms:
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1.fast heartbeat or palpitations

2.Breathlessness

3.fainting

4.chest pain

Signs:
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1.Pulse is fast and irregular in rhythm and strength

2.Angina pectoris(pain over heart area)

3.Congestive cardiac failure with ankle swelling and breathlessness

4.exercise intolerance

5.Abnormal ECG reading with absent P waves and irregular rhythm

6.Underlying heart disease such as hypertension, pericarditis, valvular disease of heart,

7.Underlying systemic disease such as hyperthyroidism, diabetes, stroke


How is diagnosis of Atrial Fibrillation made?
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1. History and physical examination

Palpitations, atrial fibrillation episodes

2. Blood tests:

renal function and electrolytes,
thyroid hormones, thyroid-stimulating hormone,
blood count.

Where there is chest pain,

blood cardiac enzymes and
coagulation tests are also done

3.Electrocardiogram

a.absence of P waves,
b.irregularity of R-R interval due to irregular conduction of impulses

4.Echocardiography

transthoracic echocardiogram is done in newly diagnosed AF to detect

valvular heart disease ,
left and right atrial size,
left ventricular size and function,
peak right ventricular pressure ,
presence of left ventricular hypertrophy
pericardial disease

5. Chest X-ray

chest X-ray is generally only performed if a pulmonary cause of atrial fibrillation is suggested,

6.Transesophageal echocardiogram

transesophageal echocardiogram (TEE) is done to detect thrombus formation

7.Ambulatory holter monitoring

A holter monitor is a heart monitor which can be worn by the patient to check the heart rate and heart rhythm for 24 hours.

It can detect presence of AF.

8.Exercise stress testing

A threadmill test can gauge the heart rate in response to exertion.

A Simple Guide to Coronary Heart Disease

A Simple Guide to Coronary Heart Disease
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What is Coronary Heart Disease?
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Coronary Heart Disease occurs when the coronary arteries become blocked. The blood supply to the part of the heart cannot provide the oxygen and nutrients to the muscles of the heart.
The cells in that part of the heart died off and that part of the heart is unable to function properly.
This is called a heart attack.

Coronary Heart Disease can lead to sudden death.

What causes Coronary Heart Disease?
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Coronary Heart Disease occurs when

1.there is a blockage of an artery in the heart by a blood clot, piece of fat or air bubble travelling in the blood from another part of the body.
This leads to lack of supply of oxygen and nutrients to the heart muscle.
As a result the heart cells died leading to loss of function of the part of the heart.

2.narrowing of the blood vessel due to fat deposit in the walls of the artery supplying blood to the heart.
This reduce the blood supply of oxygen and nutrients to the heart muscles cells and affects its function.

What are the risk factors in Coronary Heart Disease:
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1.High Blood pressure-
Hypertension narrows the arteries of the heart and causes blockage

2.High cholesterol-
Cholesterol deposit thickens the walls of the arteries, making them narrow and reducing blood flow.

3.Diabetes mellitus
The high blood sugar level thickens the arteries and make the blood thick so that less blood is able to flow through them.

4.Obesity
A BMI of 23.0kg/m² and above increases the risk of getting high blood pressure, diabetes and heart attack.

5.Smoking
Tobacco smoke narrows arteries and reduces oxygen supply to the heart.

6.Drinking of Alcohol
Alcohol can cause liver and kidney damage. increase blood pressure and affect diabetes

7.Stress
Repeated stress, if poorly controlled, can lead to high blood pressure.

What is a Angina Pectoris?
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It is a early warning sign of a ischemic heart disease.
Angina occurs when the blood supply of the heart is partially blocked by narrowing of the blood vessel.

1.It occurs during exertion when the supply of the blood to the heart is insufficient to keep up with the increase demands of the heart muscles.

2.It can also occurs when anger or fear causes the heart muscles to pump faster to supply the body with oxygen.

3.Stress can also causes spasm of the cornonary arteries reducing oxygen to the heart tissues.

4.Smoking can also constrict the blood arteries to the heart.

The symptoms of Angina Pectoris are:
1. Crushing heavy pain in the sternal area of the chest or chest discomfort lasting 2-10 mins

2.It occurs during exertion, anger or stress

3.It is relieved by rest or taking sublingual
nitroglycerin.

4. The major sign is ST depression in the ECG (electrocardiogram) during the attack which becomes normal after the attack.

5.Threadmill examination can spark off an attack of angina because of the exertion involved in doing the threadmill so it is not advisable to do a threadmill at this stage.

What are the symptoms of Coronary Heart Disease?
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The symptoms of Coronary Heart Disease are :

1.Crushing heavy (not sharp) chest pains in the mid sternal region of the chest which may radiate to the Left jaw, neck, shoulder and down the inside of the left arm and hand.
This pain occurs when not enough oxygen is supplied to the heart muscles.
The pain is usually not relieved by rest or nitroglycerin.

2.Breathing difficulty is usually associated with the chest pain due to the lack of oxygen being pumped from the heart to the lungs. The patient finds difficulty in lying flat and needs to sit up or in a inclined position.

3.Cold sweats may also be associated with the chest pain

4.Paleness of the face due to poor flow of blood from the heart

5.Fatique and tiredness

6.Confusion, dizziness, depression,

7. Difficulty in movement and speaking

How is the diagnosis of Coronary Heart Disease done?
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Diagnosis of coronary heart disease is usually confirmed by:
1.History of chest pain and physical examination of the heart and blood pressure

2.ECG(electrocardiogram)shows typical features of depression in Q wave, ST segment and raised RS segment.
A 12 leads ECG may showed the presence of Coronary heart disease more clearly

3.Threadmill -Features of ECG is enhanced during exertion on the threadmill

4.CAT scan of the heart- a new technology where the complete scan of the heart with the movement of dye through the coronary ateries can show presence of narrowing or blockage of the arteries.

5.Angiogram( cardiac catheterisation)- a small catheter is entered into the artery at the groin.
The catheter is guided through the blood vessel to the coronary arteries with the aid of a special x-ray machine.
A radio-opaque dye is injected into the artery and its passage is recorded on a screen.
Occlusion or narrowing of any of the coronary arteries can be seen.

6.intravascular ultrasound (IVUS) and fractional flow reserve (FFR), may be performed together with cardiac catheterization to obtain more detailed images of the walls of the blood vessels.

7.Blood cardiac enzymes and ESR may be raised.

All acute Coronary Heart Disease attacks are Emergencies and should be admitted to hospital as soon as possible for proper treatment.

The treatment of Coronary Heart Disease will be discussed in the Simple Treatment of Coronary Heart Disease Part 2.