UNC Health Talk

You’ve Been Diagnosed with Atrial Fibrillation. Now What?

If you’ve been diagnosed with atrial fibrillation, you’re not alone. AFib is the most common heart-rhythm disorder in the world, affecting an estimated 2.7 million to 6.1 million Americans.

In AFib, the top chambers of the heart, called the atria, fibrillate (quiver or twitch quickly) instead of fully contracting. This causes the bottom chambers of the heart to beat irregularly. A normal heart rate is about 60 to 100 beats per minute. When you are in AFib, your heartbeat will be irregular and can surge up to 200 beats per minute.

Left untreated, a fast, irregular pulse over long periods can weaken your heart muscle and lead to heart failure. However, with proper treatment, you can live an active, normal life with AFib.

We talked to UNC AFib Care Network coordinator Tiffany Armbruster, a certified adult-gerontology nurse practitioner, to learn how you can manage your AFib and avoid unnecessary, costly trips to the emergency room.

Getting to the Root Cause

While AFib is a common, treatable condition, it is important to get proper treatment. In addition to the increased risk of heart failure, patients with AFib are at a much higher risk of stroke.

“The first discussion we have with a patient who has been diagnosed with AFib is about their increased risk for stroke. AFib patients who are 65 or older, have diabetes, hypertension or heart failure are at even higher risk than patients with AFib and no other chronic conditions,” Armbruster says.

The key to long-term management of AFib, she says, is controlling any underlying diseases.

“Treating AFib is more than just managing the rhythm disorder, because AFib is really a symptom of other underlying conditions,” Armbruster says. “So we try to focus on AFib prevention by addressing risk factors such as high blood pressure, sleep apnea and obesity.”

Other risk factors for AFib are thyroid disease, diabetes, heart failure, heart valve disease, excessive alcohol or stimulant use and chronic lung disease.

Armbruster says proper management of AFib requires a multidisciplinary approach.

“It hinges on good communication between specialists such as your cardiologist, electrophysiologist and your primary care doctor, as well as any other member of your care team,” she says.

UNC AFib Care Network’s Transitions of Care Clinic

Because coordination of care is so important, UNC AFib Care Network offers the AFib Transitions of Care clinics.

“These clinics serve as landing spots for patients who went to the ER or urgent care clinic with symptoms of AFib,” Armbruster says. “Patients with AFib can be discharged from the ER with follow-up in the AFib transitions clinic as soon as the following day.”

The provider in the clinic acts as a navigator for these patients to address any acute AFib issues, coordinate care among their primary care team and ensure they have a follow-up plan to address the risk factors and conditions that contribute to their AFib.

In addition, they make sure newly diagnosed patients have an individualized care plan. An important part of this plan is to make sure patients understand what AFib is and is not.

Common symptoms of AFib are:

  • Fatigue or lack of energy
  • Dizziness, lightheadedness or fainting
  • Chest pain, pressure or tightness
  • Shortness of breath
  • Heart pounding or racing
  • Increased urination
  • Trouble completing daily activities

“A lot of patients have symptoms and they get scared. They think they’re having a heart attack or another serious problem, so we educate them on what is common to experience with AFib,” Armbruster says. “Then we help them develop an individualized action plan for when they have AFib symptoms with their next AFib episode.”

Managing Your AFib

Armbruster says the first step to managing an AFib episode is to know your symptoms.

“Everybody experiences AFib differently. Some have no symptoms at all, and some people are completely debilitated and can’t get out of bed when they have an episode,” Armbruster says.

Understanding your specific symptoms will help you determine the severity of the episode.

“If during your typical episode, you’re a little short of breath when you walk or a little more tired than usual, you know that when you experience those symptoms that it’s most likely due to your AFib,” she says. “And if you’re having a typical episode, there’s no need to panic. If you feel OK, you can manage your episode at home.”

To do this, Armbruster teaches patients strategies to get through an episode, such as deep breathing exercises or taking an additional dose of medication for rapid heart rate. Examples of prescribed medications that slow down the heart rate are beta blockers (metoprolol, propranolol) and calcium channel blockers (diltiazem, verapamil).

She also teaches patients how to take their pulse.

“By doing a simple manual pulse check, you can not only figure out how fast your heart rate is going, you can also detect if there are irregularities in your pulse,” Armbruster says. “If you’re feeling symptoms, you can check your pulse and if it’s irregular, you are likely having an AFib episode. If it’s not irregular, you’re probably not in AFib and your symptoms may be caused by something else.”

Some patients purchase a commercial device to help monitor their heart rate or heart rhythm, such as a Fitbit or an Apple Watch. However, it is important to also learn how to do a manual pulse check because these devices can sometimes be unreliable.

Armbruster says that being able to calculate your heart rate also helps with your treatment plan, because you can know when to take medication for your AFib.

AFib patients are often prescribed oral blood-thinning medications to reduce their stroke risk and medications to control their heart rate. Some patients take medications daily, while others take them only as needed if they experience rapid heart rate with an AFib episode.

“Many patients take medications daily and supplement with additional doses as needed, but patients should only do this if they have been instructed to do so by their provider,” Armbruster says. “By doing these things at home to control your episodes, hopefully you can stay out of the hospital and avoid the ER.”

When to Call the Doctor or 911

If an AFib episode lasts 24 to 48 hours with no break or if symptoms worsen, call your physician, Armbruster says.

Call 911 or go to the emergency room immediately if you experience any symptoms of a stroke, which are sudden weakness or numbness or difficulty speaking or seeing. You should also seek emergency care if you pass out or feel like you’re going to pass out, if you have significant shortness of breath or severe lightheadedness or if you feel weak, cold or clammy.

Although patients with AFib can develop chest pain with an AFib episode, chest pain that persists for more than five to 10 minutes and is not clearly associated with an AFib episode can also be from a heart attack. Seek urgent medical attention.

“The bottom line is: Listen to your body,” Armbruster says.

If you’re concerned about AFib, talk to your doctor or contact the UNC AFib Care Network, which offers a quarterly support group at the UNC Wellness Center for patients and family members.