September is National Atrial Fibrillation Awareness Month, so it’s as good a time as any to brush up on this condition, especially since there’s a link between diabetes and atrial fibrillation.
What is atrial fibrillation?
The Centers for Disease Control and Prevention (CDC) estimate that between 2.7 and 6.1 million people in the U.S. have atrial fibrillation. Atrial fibrillation, often called “Afib” or “AF,” is a fancy term for an irregular or abnormal heartbeat that often occurs with a rapid heart rate. An irregular heartbeat is called an arrhythmia. There are many different types of arrhythmias, including:
A fast heart rhythm with a rate of more than 100 beats per minute
A slow heart rhythm with a rate of less than 60 beats per minute
Arrhythmias that start in the atria (the upper chambers of the heart)
Arrhythmias that start in the ventricles (the lower chambers of the heart)
Slow rhythms that occur due to a problem in the heart’s electrical conduction system
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Afib is a type of supraventricular arrhythmia (and one of the most common). It happens when the atria beat rapidly and out of sync with the ventricles. Normally, the heart beats very efficiently to pump blood to the rest of the body. The atria contract first, then the ventricles. The timing of these contractions is regulated by the heart’s electrical system.
The sinoatrial (SA) node is located in the right atrium of the heart, and that’s where the electrical impulse begins to contract the heart. The impulse then goes to the atrioventricular (AV) node (in the septum of the heart) which spreads the impulse from the atria to the ventricles, causing them to contract and pump blood from the heart.
With Afib, things go awry with the usually smooth and coordinated heart contractions. Instead of the SA node directing the heart rhythm, electrical impulses start to fire all at once, causing a fast, chaotic heart rhythm. The atria are unable to contract and move blood into the ventricles; they then contract irregularly and cause a fast, irregular heartbeat.
What are the symptoms of Afib?
Not everyone who has Afib has symptoms, but the most common symptoms are:
· Heart palpitations (these feel like your heart is skipping beats or fluttering)
· Shortness of breath
· Chest pain
Afib can last several minutes or hours at a time. If you have this condition, you may have occasional, or paroxysmal, Afib; persistent Afib that needs medication or electrical shock to restore the heart rhythm; long-standing persistent Afib that is continuous and lasts for more than a year; or permanent Afib that requires medication to control your heart rate.
What causes Afib?
There are certain conditions that can cause heart damage and lead to Afib, including:
· Heart attack
· Heart surgery
· Coronary heart disease
· Congestive heart failure
· Heart valve disease
· Congenital heart defects
· Chronic lung disease
· Pulmonary embolism
· Viral infections
Stimulants, such as caffeine, alcohol and tobacco can cause Afib. In some cases, there is no identified cause of Afib. This is called lone atrial fibrillation.
What are the complications of Afib?
One of the main concerns with Afib is that it may increase the risk of blood clots and having a stroke. It can also lead to other medical issues, such as heart failure, other heart rhythm problems, inconsistent blood supply and chronic fatigue.
Who is at risk of getting Afib?
According to the CDC, having high blood pressure accounts for about one in five cases of Afib. Other risk factors are:
· Older age
· Being male
· European ancestry
· Heart failure
· Ischemic heart disease
· Enlargement of the chambers on the left side of the heart
· Chronic kidney disease
· Sleep apnea
· Lung disease
· Moderate to heavy alcohol use
How do you know if you have Afib?
Be sure to see your healthcare provider if you have any symptoms of Afib (see above). Your provider should ask you about your symptoms, review your medical history and do a physical exam. Common tests that you might have are:
This provide a picture of your heart’s rhythm
A small recorder that you wear for 24 hours or up to several days that records the heart’s rhythm
Portable event monitor
A monitor worn for a longer period of time for people who have less frequent Afib symptoms
A device that uses sound waves that creates moving pictures of your heart
This provides an image of your lungs and heart to rule out other conditions
Your provider may also order blood tests and a stress test, as well.
How is Afib treated?
Treatment for Afib and lowering the risk of stroke and other complications depends on the underlying cause. For example, someone with untreated hyperthyroidism who develops Afib needs to get their thyroid back on track, so thyroid medication may be prescribed. Likewise, a person who notices that caffeine triggers Afib symptoms will obviously benefit from decreasing their intake of coffee, tea or other beverages containing caffeine.
Medications for Afib
The goals of treatment are to restore a normal heart rhythm and heart rate and lower the risk of stroke. Medications are generally the first line of treatment and may include:
· Antiarrhythmic drugs to restore the heart to its normal rhythm (e.g., Norpace, Betapace)
· Rate control drugs to control how fast your heart beats (e.g., digoxin, beta blockers, calcium channel blockers)
· Anticoagulant drugs (“blood thinners”) to reduce the risk of blood clots (e.g., warfarin, dabigatran, rivaroxaban)
As with any medication, there are side effects to the above drugs that will likely require careful monitoring. For example, antiarrhythmic drugs may cause more arrhythmias, and anticoagulants can increase the risk of bleeding.
Lifestyle changes for Afib
Lifestyle changes can play a big role in managing symptoms and episodes of Afib, depending on the underlying cause. Steps you can take include:
· Limiting caffeine
· Managing blood sugar levels
· Managing high blood pressure
· Treating sleep apnea
· Aiming for a healthy weight
Additional treatments for Afib:
If medication and lifestyle changes aren’t enough to help manage Afib, there are other methods that might be considered:
· Electrical cardioversion: An electrical shock using paddles or patches is given to reset the heart’s rhythm
· Ablation: A catheter is guided through blood vessels to your heart to destroy tissue that is causing the Afib
· Pacemaker: This is a device that is implanted in the chest to help maintain the heart rate
· Left atrial appendage closure: A device called a left atrial appendage closure device is inserted through a catheter to close a pouch-like part of the left atrium to prevent clots from forming.
· Maze procedure: A procedure that involves incisions in the atria to create scar tissue which prevents abnormal impulses.
What is the link between Afib and diabetes?
Between 9% and 15% of people with diabetes have Afib. Why? Having diabetes is a risk factor for Afib. In addition, high blood pressure, chronic kidney disease, sleep apnea and obesity are more common in people with diabetes than without the condition; these, too, can increase your risk of Afib.
Diabetes is thought to cause hypertrophy of the heart, which is a thickening of the heart muscle that can affect the heart’s electrical system. Researchers think that this hypertrophy may be caused by high blood sugar levels.
Both diabetes and Afib increase your risk for heart disease and stroke. It’s very important to make sure both of these conditions are effectively treated. Lifestyle changes are important, and the good news is that eating healthfully, staying physically active, losing even a small amount of weight, and not smoking will go a long way to help you manage diabetes and Afib, as well as related conditions, such as high blood pressure. You may also need medication to help you manage your diabetes and Afib, too.
It’s important to work with your healthcare team to coordinate a treatment plan that works for your diabetes and Afib symptoms. You can take steps to prevent Afib, too: one of the most important of these steps is to reach a healthy weight. Studies show that people who are overweight have a higher risk of Afib. The more you weigh, the higher your risk. Another key step is to get regular physical activity. Exercise helps reduce or even eliminate Afib symptoms (and it helps your blood sugars and blood pressure at the same time!).
Want to learn more about keeping your heart healthy with diabetes? Read “Lower Your Risk of Heart Disease,” “Tips for a Healthy Heart” and “Fight Off Heart Disease With These Five Heart-Healthy Foods.”