Mir Ali, MD, FACC, of the Heart, Artery and Vein Institute of Payson, recently discussed atrial fibrillation with members of Banner High Country Seniors in a Doc Talk.

He gave the following explanation of atrial fibrillation: the heart’s upper chambers (atria) beat out of coordination with lower chambers (ventricles). Ali said, “This condition may have no symptoms. Some people report palpitations, shortness of breath, or fatigue.”

He offered the following descriptions of the possible symptoms of atrial fibrillation:

• Palpitations is the sensation of an accelerated and

irregular heartbeat

• Fatigue is physical tiredness

• Dyspnea is the clinical label for shortness of breath

during physical efforts

• Dizziness or light-headedness

• Angina, which is retrosternal chest pain and


• Syncope or fainting

However, it is more common not to have any symptoms. Atrial fibrillation is usually discovered accidentally. See your doctor for an EKG, as you may not have any symptoms. The EKG reads current status only, so AFib may not show up on an EKG. A Holter monitoring device expands monitoring for up to 24 hours so is more likely to catch AFib. A stress test can also help to diagnose AFib.

Ali said treatment includes drugs, electrical shock (cardioversion) and minimally invasive surgery (ablation).


When the heart is in AFib, the arterial appendage blood may clot. The blood clot can go directly to the brain, so the most common complication of AFib is a stroke.

What do blood pressure and the rhythm of your heart have to do with stroke risk?

Consider this: about three out of four people who have a stroke have high blood pressure; atrial fibrillation is present in about one out of five strokes.

How do you control blood pressure? Salt causes high blood pressure and many other health issues. You can reduce half of your risk if salt is monitored. Restaurants always serve too much salt. The only way to control salt in your diet is to only cook at home.

Who is at risk?

• Advanced age

• Valve problems

• Weakly contracting heart

• Heart attack

• Heart not receiving enough blood

• Drinking alcohol

• Family history

• Sleep apnea — Lack of adequate sleep is a huge risk


• Athletes

• Other chronic conditions, such as thyroid problems;

diabetes; asthma

Stroke Warning Signs

Remember the mnemonic: F.A.S.T. — Face Drooping; Arm Weakness; Speech Difficulty; Time to call 911.

Stroke risk factors include:

• History of high blood pressure

• Increased age

• Previous stroke or transient ischemic attack (TIA)

• Diabetes

• Heart disease

• Family history

• Obesity

• Smoking

How are heart attack symptoms different from AFib symptoms?

Fluttering and palpitations are key symptoms of AFib and is the key difference,

Many heart problems have similar warning signs.

If you think you may be having a heart attack, get emergency help immediately by calling 911.

Some heart attacks are sudden and intense. But most heart attacks start slowly, with mild pain or discomfort.

Heart attack warning signs may include: chest discomfort; discomfort in other areas of the upper body; shortness of breath; breaking out in a cold sweat, nausea or lightheadedness.

Items to discuss with your doctor

How serious is my AFib?

What are my medication options?

What are my treatment goals?

In what ways does AFib increase my health risks?

Do I need to make lifestyle changes?

Should I change any of the following to reduce my risks? —eating habits; weight; smoking; physical activity.

One possible treatment is anticoagulant therapy. It could be a consideration where there is congestive heart failure; hypertension (high blood pressure); age is 75 or older; diabetes; or there has been a prior stroke.

Medication can change the blood’s ability to coagulate.

If you have these conditions, your doctor may place you on a blood thinner — vascular disease (prior heart attack, peripheral artery disease or aortic plaque); age 65-74; female.

Drugs such as blood thinners are given to patients to prevent blood clot formation:

• Warfarin / Coumadin

• Anticoagulants — dabigitran; rivaroxaban; edoxaban

and apixaban (direct-acting oral anticoagulants or

DOACs); aspirin.

Electrical cardioversion

Electrical shock on the outside of the chest (while under mild anesthesia) using paddles or patches. The shock can be used to “reset” the heart to a normal rhythm.

Atrial Fibrillation Prevention and Risk Reduction

• Restoring the heart to a normal rhythm

• Reducing an overly high heart rate

• Preventing blood clots (stroke)

• Preventing heart failure

The most common treatment is ablation (procedure of choice as it cures AFib). The doctor accesses via the groin to detect which part of the heart is responsible, and then they kill that tissue. It may require 2-3 times.

To reduce risk of complications associated with AFib get regular physical activity; eat a heart-healthy diet, low in salt, saturated fats, trans fats, and cholesterol; manage high blood pressure; avoid excessive amounts of alcohol and caffeine (if you have AFib, do not drink coffee, not even decaf).

Medication for AFib is not very helpful, may do more harm than good.

Blood pressure medications can improve quality and quantity of life.

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