Atrial Fibrillation

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Causes

Many conditions can cause disorganized electrical activity in the atria to develop. In many cases, a "leaky" or a sticky (stenotic) mitral valve can result in an enlarged (dilated) atria.

Patients with a history of high blood pressure (hypertension), can develop atrial fibrillation, because high blood pressure eventually begins to affect the atria.

Blockages in the arteries that supply the heart with blood (coronary arteries), heart attacks, and an overactive thyroid gland can also lead to atrial fibrillation.

Excessive consumption of alcohol acts as a toxin on the heart, and patients who binge drink or chronically drink large amounts of alcohol are at risk for developing atrial fibrillation.

Patients with heart failure, in which the left ventricle, the heart's main pumping chamber, does not pump blood normally, may develop atrial fibrillation as blood "backs up" from the left ventricle into the left atrium.

Rarely, a blood clot develops in the legs and travels to the lungs, causing a pulmonary embolus that can trigger atrial fibrillation.

Pericarditis (inflammation of the tissue that surrounds the heart, the pericardium) can irritate the atria and lead to atrial fibrillation.

In some patients, there simply is no clear cause for the condition.

Signs and Symptoms

As atrial fibrillation develops, the patient may be unaware of symptoms. The condition may be discovered incidentally, when a physician notices that the patient's heart rate is no longer regular. Sometimes, the development of shortness of breath or of fatigue compels a patient to seek medical attention. Unfortunately, some patients do not see a doctor until they have suffered a stroke.

Blood may "back up" into the lungs, resulting in the accumulation of fluid. This interferes with normal absorption of oxygen from the lungs into the bloodstream, which can lead to the sensation of shortness of breath. Some patients notice this when they exercise or exert themselves. Others notice it when they lie down at night and find they must sleep with their head elevated to avoid waking up short of breath. Fluid can accumulate in the feet, ankles, legs, and sometimes the abdomen as well, causing swelling (edema).

Also, when the amount of blood being pumped throughout the body decreases, the patient may experience fatigue. When too little blood reaches the brain, the patient may experience lightheadedness or fainting. When contractions become very rapid, sometimes 200 per minute, the patient experiences palpitations.

Complications
The most devastating complication of atrial fibrillation occurs when a blood clot forms in the left atrium, travels to the left ventricle, and is pumped to the brain. When a blood clot lodges in one of the arteries supplying the brain with blood, it can block blood flow to that part of the brain and cause a stroke. Stroke can be severe and can cause permanent paralysis of part of the body, speech impairment, and even death. Unfortunately, stroke can occur at any time, usually without warning.

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