What is Atrial Fibrillation and Do You Need to See a Cardiologist?

Your heart may skip a beat at the thought of a loved one or race when preparing for that big presentation at work. Those sympathetic responses are normal. But an irregular heart rhythm that outlasts life’s little moments is not.

We spoke to Ashesh Parikh, D.O., a cardiologist and physician on the medical staff at Texas Health Plano and Presbyterian Heart & Vascular Group, a Texas Health Physicians Group practice, to understand what causes an irregular heart rhythm and how to know when to reach out to your primary care physician or seek out a cardiologist for care.

When the two atria (upper chambers of the heart) beat irregularly, their ability to pump blood to the lower chambers (ventricles) is negatively affected, causing troublesome symptoms and increasing the risk of heart-related death. This condition is referred to as Atrial fibrillation or A-fib. A-fib is dangerous because it not only affects the heart but also significantly increases a person’s risk for a stroke. When blood doesn’t pump regularly, it can pool in the heart and create clots, which can dislodge from the heart and travel to the brain and lead to a stroke.

According to the American Heart Association, an estimated 2.7 million Americans are living with A-fib and it is the most common “serious” heart rhythm abnormality in people over the age of 65 years. A-fib is becoming increasingly common in North Texas. According to the Centers for Medicare & Medicaid Services, almost nine out of every 100 Medicare beneficiaries were treated for A-fib in 2017.

The most common symptoms include:

  • A pulse that feels too fast, too slow, fluttering, pounding or irregular
  • Fatigue
  • Confusion
  • Chest pain
  • Dizziness, lightheadedness and/or fainting
  • Shortness of breath
  • An inability to exercise or perform strenuous tasks

But Parikh notes that about 60 to 70 percent of patients show no symptoms of A-fib, making annual trips to your primary care physician even more important.

“Most of the time, the way we discover that they have A-fib is when they come in for a routine exam and we take their blood pressure and heart rate and discover that their rhythm is irregular,” Parikh says. “Sometimes we don’t even discover the symptoms until a patient has already experienced a stroke. You start running tests when they come into the hospital only to discover they’ve been in A-fib which is most likely what led to the stroke.”

For that reason, Parikh says it’s important to see your primary care physician every year and ask him or her if they’d recommend an electrocardiogram (EKG) based on your risk factors, symptoms or medical history, especially if you’re over the age of 50. An EKG is a simple, painless test that measures the electrical activity of the heartbeat and can be done in most PCP offices.

The National Heart, Lung, and Blood Institute reports the following risk factors for A-fib:

  • 65 years old or older
  • High blood pressure
  • Heart failure, coronary heart disease or rheumatic heart disease
  • Congenital or structural heart defects
  • Pericarditis
  • Sick sinus syndrome
  •  Hyperthyroidism
  • Obesity
  • Diabetes
  • Lung disease
  • Sleep apnea
  • Metabolic syndrome
  • High dose steroid therapy
  • Heavy alcohol use
  • Caffeine consumption
  • Psychological stress
  • Recent surgery
  • During a heart attack
  • Genetic factors

According to the American Heart Association (AHA), untreated atrial fibrillation doubles the risk of heart-related deaths and results in five times the risk for stroke. If a patient is diagnosed with atrial fibrillation, the course of treatment will often depend on his or her risk factors. If a risk factor is found to contribute to the condition, treating the underlying cause may be enough to eliminate A-fib.

However, some patients may need medications to reduce their risk, including blood thinners to prevent blood clots or medications called beta-blockers to control the rate at which the heart beats. If your primary care physician discovers you have A-fib, they will refer you to a cardiologist for a follow-up and additional tests if needed, such as electrical cardioversion or catheter ablation. But thankfully, most treatment can be managed by your PCP.

“For anything you have a question for, family doctors are a great first line for any medical concerns,” Parikh adds. “If you’re concerned, I’d say there is probably not one family doctor who would say ‘no’ to a request from a patient to do an EKG. It doesn’t even necessarily require an appointment to see the doctor. One of the nurses or medical assistants can do a quick EKG then show the results to the doctor to confirm or deny, and that’s something simple that can put you at ease.

“My rule of thumb is that if this is a new symptom or something that has never happened to you before, reach out to your family doctor to get it checked out, do an EKG or started on medication if it is A-fib. If you have a known diagnosis of A-fib and you’re having more symptoms, you could contact either your cardiologist or your family doctor for further care and we can communicate between each other to coordinate your care.”

If it’s been too long since you’ve seen your primary care physician for a wellness visit or you suspect you have symptoms of AFib, you can find a physician by visiting TexasHealth.org/FindaProvider.

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