AFib and bad kidneys: A toxic combo

One of the long term consequences of chronic conditions such as diabetes, high blood pressure and even severe obesity is the development of chronic kidney disease. In fact it is estimated that the number of patients with chronic kidney disease is more than doubling every decade. What is also a major concern is that as chronic kidney disease is an exceptionally inflammatory condition, it substantia [...]

AF in the Young

Most of the AF we see occurs in older patients - usually those above the age of 60 and therefore much of what we know about AF comes from studies involving older patients. What we are however beginning to realise is that AF can occur in younger patients too and perhaps this group of patients represents a group that we do need to study and research a lot more because what we understand about the ca [...]

AF: The Silent Enemy

Patients can have AF without experiencing any symptoms whatsoever. This is termed silent AF. The problem here is that patients may be experiencing a heart rhythm disturbance which is associated with an increased risk of stroke without knowing anything about it. It is always difficult to be accurate about the prevalence of silent AF but it is estimated that 10-40% of all AF patients are asymptomati [...]

I have atrial fibrillation (Afib) but I don’t want to take blood thinners

Patients with a diagnosis of atrial fibrillation (Afib) who are above the age of 65 or who have co-morbidities such as heart failure, diabetes, high blood pressure, vascular disease or previous strokes are believed to be at a higher risk of future strokes. There is overwhelming evidence that such patients should be started on lifelong stroke prevention medications. All currently prescribed stroke- [...]

Afib, strokes and bleeding: Enter the Watchman

Introduction Patients with AF who are above the age of 65, or have co-morbidities such as diabetes, high blood pressure, vascular disease or heart failure are at an increased risk of stroke. It is understood that these patients are at a higher risk of stagnation of blood within the heart; the stagnant blood can form clots within the heart and these clots can get dislodged, travel to the brain, and [...]

Why everyone with Afib should have an echocardiogram

An echocardiogram is an ultrasound-based assessment of the heart.  It is painless, harmless, readily available in most hospitals and can give a large amount of very useful information about the structure and function of the heart.  As atrial fibrillation can be caused by a structural problem with the heart such as heart valve disease or heart muscle weakness, the echo can help to elucidate the und [...]

Atrial Flutter?

What is atrial flutter? Atrial flutter is an abnormal heart rhythm. In atrial flutter, the atria contract at 300 beats per minute and every other impulse goes down into the ventricles and therefore the ventricles beat at 150 beats per minute. In patients who are taking medications such as beta blockers or calcium blockers the impulses reaching the ventricles may be reduced even more so the heart r [...]

Understanding anticoagulation in AF

Anticoagulants act by delaying the ability of blood to form clots. Doctors commonly refer to them as ‘blood thinners’ however strictly speaking they don't thin the blood but merely reduce the ability for the blood to clot. Commonly used anticoagulants which can be taken orally include Warfarin and the NOACs. There is an anticoagulant which can be used as an injection called Heparin but it is impra [...]

Understanding Anticoagulation in Atrial Fibrillation

Patients who have been diagnosed with atrial fibrillation (AF) and who are above the age of 65 or have co-morbidities such as high blood pressure, Diabetes, heart failure or vascular disease have a 5-fold higher risk of suffering strokes. A significant proportion of the strokes are believed to be as a consequence of blood clots which have formed within the heart and then been dislodged and travell [...]

How to convince your GP to prescribe you a NOAC instead of Warfarin for your AF

Introduction Patients who suffer from AF and who are above the age of 65 years or have additional comorbidities such as diabetes, high blood pressure, heart failure and vascular disease have a much higher risk of suffering a stroke and it is for this reason they are prescribed anticoagulants. For several years, the only available oral anticoagulant which was proven to reduce strokes in such patien [...]

Atrial fibrillation and flying

For patients with AF, flying can be a daunting prospect. Firstly, provided your AF is well controlled and you are not extremely symptomatic, there is no reason why you can’t fly. The following tips may help you have a worry-free trip. You should declare your AF to your travel insurer and consider buying specialist AF travel cover. It is important to take all the medications that you need and keep [...]

Atrial fibrillation and driving

It is always advisable to look on the DVLA website (www.direct.gov.uk/driverhealth) to get the most up to date guidance on driving if you have AF. At the time of writing this book, the guidance is as follows: If you hold an ordinary licence, and your heart rate is well controlled, then you can drive. However if you are having bad symptoms at the wheel then it is recommended that you do not drive, [...]

Atrial fibrillation and Sex

Patients with AF may experience sexual problems for 3 main reasons: Anxiety about whether they may be harming their heart or risking making their AF worse. Co-morbidities such as Diabetes, hypertension and vascular disease can cause erectile dysfunction in men Medications used in AF such as betablockers can also cause erectile dysfunction in men There is no evidence or good reason why patients wit [...]