One-third of Americans with atrial fibrillation don’t know they have it.
Atrial fibrillation can be a puzzle — one that takes a degree of sleuthing to solve. That’s because when you do have the signs, they can be subtle. And for some, atrial fibrillation, or afib as it’s called, doesn’t always give symptoms. Estimates are that about 733,000 Americans are living with undiagnosed atrial fibrillation, according to the National Stroke Association.
Is It Atrial Fibrillation?
You might tire easily or feel your heart pounding or fluttering at times. You might faint or dizzy. You could have chest pain. Your doctor might hear your irregular heartbeat during a routine physical, or it might take wearing a monitor for several days for this heart condition to be picked up.
Atrial fibrillation starts in the upper portions of the heart, called the atria. The atria contract too quickly and fall out of rhythm with the lower section of the heart, the ventricles. Sometimes this may limit the amount of blood the ventricles can pump forward to the rest of the body. One sign of the heart’s inability to pump enough blood is shortness of breath. Even more dangerous, though, is that people with atrial fibrillation are more likely to have a stroke.
Knowing the signs and symptoms of afib as well as the most common risk factors will help you know when to suspect afib.
What Puts You at Risk for Atrial Fibrillation
Although the exact causes of atrial fibrillation are unclear, you should be aware of the risk factors, said Marie-Noelle Langan, MD, a member of the senior faculty of cardiology at Mount Sinai Hospital in New York City.
Atrial fibrillation risk factors include:
High blood pressure. This is at the top of the list. With high blood pressure, the force of the blood flow in your body is stronger than it should be. This consistent pressure extends the walls of the atria, potentially contributing to afib.
Existing heart conditions. Dr. Langan said two primary conditions increase your risk for atrial fibrillation. First, in coronary disease, a buildup of plaque blocks the arteries. Second, is valve disease, which leads to a problem with blood flow between the chambers of the heart. Your risk also increases after a heart attack, after heart surgery, or if you have heart failure.
Diabetes. This condition affects your metabolism and impacts sugar levels in the blood. Among other things, diabetes increases risk for heart disease and kidney disease.
Age. “As you get older, the valves get tired and slow down,” Langan said, which explains the higher rates of atrial fibrillation in older adults. According to the National Stroke Association, 5 percent of Americans over 65 have atrial fibrillation and 10 percent over 80 do.
Hyperthyroidism. About 5 percent of afib cases are linked to hyperthyroidism. This condition is an overactive thyroid and it occurs when the gland produces too much thyroid hormone. The increased hormone levels affect metabolism and contribute to atrial fibrillation.
Alcohol. Alcohol affects people’s personalities differently, and its relationship to the heart varies too. Alcohol can weaken heart muscles, increase blood pressure, and make it difficult for the heart to pump blood effectively. Binge drinking in particular has been associated with afib. To keep a healthy heart, the American Heart Association recommends drinking only in moderation — one drink a day for women and up to two for men.
Sleep apnea. This sleep disorder causes you to stop breathing at night and, in turn, slows your heart rate. Langan said the connection between sleep apnea and atrial fibrillation is not totally understood. It could be due to a hormone the body produces in response to the pause in breathing. In addition, the heart will often try to overcompensate for beating slowly by beating too quickly, leading to atrial fibrillation.
What Afib Feels Like
Though you may also experience weakness, chest pain, fainting, and fatigue, there are two characteristic symptoms of afib:
Shortness of breath. The heart beats much faster after less physical activity when you have atrial fibrillation, making shortness of breath a relatively common symptom.
Noticeable chest palpitations. These come from the irregular beating of the heart. When your heart is working normally, you generally don’t feel it, Langan said. Many of her afib patients have described their heartbeats as butterflies in the chest. Others experience a pounding sensation.
Further complicating the picture is that there are different types of atrial fibrillation. In chronic fibrillation, the atria are always contracting irregularly. In paroxysmal fibrillation, the heart slips in and out of irregular contractions. People with chronic atrial fibrillation tend to show fewer symptoms — or none at all, Langan said. This is because they’re used to them, whereas people with paroxysmal afib may more readily feel the difference between a regular and irregular heartbeat.
Having no symptoms or simply not noticing them is common, but it doesn’t lessen your risk for stroke, heart attack, or heart failure.
“The hardest thing for clinicians is convincing people they should pay attention to this condition — even when they don’t feel it,” Langan said