SearchThrombosis and Atrial Fibrillation
The diagnosis of atrial fibrillation
Atrial fibrillation (AF) can be intermittent or persistent.4 Symptoms include palpitations, chest pain, fatigue, dyspnoea, lightheadedness, and syncope.33, 34 Some patients have no symptoms, and the diagnosis is made incidentally during a medical evaluation conducted for other reasons. Cardiovascular causes of AF include hypertension, coronary artery disease, valvular heart disease, pericarditis, and pulmonary embolism. Other causes include hyperthyroidism, alcohol intoxication, and pneumonia.22, 34
People with AF have an irregular heart rate that may be rapid.4 The diagnosis is confirmed by electrocardiography. Once the diagnosis is established, medical management involves identifying and addressing the cause of the AF and, when possible, restoring a normal cardiac rhythm.4, 33 When restoration of a normal heart rhythm is not feasible, the main goals of treatment include controlling the heart rate and minimising the risk of stroke by preventing thrombus formation in the heart.
ECG showing atrial fibrillation
Stagnant blood in the heart predisposes to thrombus formation
AF is the most common arrhythmia seen in clinical practice. An estimated 2.2 million people in the US and 4.5 million in the EU have AF.22 This arrhythmia is characterised by an irregular supraventricular rhythm with a variable ventricular rate.
People with chronic AF are in a persistent hypercoagulable state.35 In AF, blood can stagnate in the atria because of the ineffectual pumping of the upper cardiac chambers. Without anticoagulant therapy, such patients are at high risk of stroke, as a thrombus that forms in the atria can embolise to block blood flow to the brain.4, 18
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Windows Live- 4 - Lip GY, Tse HF. Management of atrial fibrillation. Lancet. 2007;370(9587):604-618.
- 33 - Padanilam BJ, Prystowsky EN. Atrial fibrillation: goals of therapy and management strategies to achieve the goals. Med Clin North Am. 2008;92(1):217-235, xii-xiii.
- 34 - Kannel WB, Benjamin EJ. Status of the epidemiology of atrial fibrillation. Med Clin North Am. 2008 ;92(1):17-40, ix.
- 22 - Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation. 2006;114(7):e257-e354.
- 35 - Li-Saw-Hee FL, Blann AD, Lip GY. A cross-sectional and diurnal study of thrombogenesis among patients with chronic atrial fibrillation. J Am Coll Cardiol. 2000;35(7):1926-1931.
- 18 - Waldo AL. Anticoagulation: stroke prevention in patients with atrial fibrillation. Med Clin North Am. 2008;92(1):143-159, xi.
- Coronary artery disease
- Coronary artery disease (CAD) is the end result of the accumulation of plaques within the walls of the arteries that supply the muscle of the heart with oxygen and nutrients. The process by which the coronary arteries become narrowed or completely occluded is known as atherosclerosis.
- Hypertension
- Persistently high arterial blood pressure. Hypertension may have no known cause (essential or idiopathic hypertension) or be associated with other primary diseases (secondary hypertension). This condition is considered a risk factor for the development of heart disease, peripheral vascular disease, stroke, and kidney disease.
- Arrhythmia
- Any variation from the normal rhythm of the heart beat (e.g., sinus arrhythmia, premature beat, heart block, atrial fibrillation, atrial flutter, pulsus alternans, and paroxysmal tachycardia).
- Hypercoagulable state
- Changes in the blood that promote coagulation.
