Heart flutter – atrial fibrillation

With heart flutter, there is rapid and irregular contraction of the front chambers of the heart. As a result, the blood does not get to where it should, but instead it can clump together to form small blood clots.

Heart flutter, or to give it its correct name, atrial fibrillation, usually causes agitation/discomfort in the chest, palpitations, laboured breathing and tiredness, though a lot of people do not experience any symptoms. By checking the patient’s pulse, the doctor can often detect an irregular heartbeat, but an ECG is needed in order to make a secure diagnosis. A number of different treatments are available, including medicines and/or electric shocks in order to restore normal rhythm. Most people are given long-term medicinal treatment, with the vast majority having to use blood-thinning medicines.

The heart’s electrical conduction system starts automatically in the right front chamber (atrium), spreading through the heart into the left front chamber and to both ventricles. Normally an electrical impulse causes contraction of the front chambers and to one contraction in the main chambers, resulting in a pulse wave. However, with heart flutter, there is electrical chaos in the front chambers, and as a result they no longer contract as they are supposed to.

Heart flutter/atrial fibrillation can come on as attacks or last for a while (days or months), or it can be constant. It becomes increasingly common with age.

 

Symptoms of heart flutter

As we have already said, a lot of people with heart flutter hardly experience any symptoms. Others may find their symptoms unpleasant or alarming. A lot of people are unaware that they have heart flutter, despite most having clear symptoms. They are often aware of palpitations with rapid, irregular heart rhythm, and they might have difficulty breathing. Almost all of them notice that they have less endurance and have more problems with physical activity. This can lead to chest pains, dizziness, anxiety, internal agitation and, in some cases, fainting. A lot of people find that heart flutter comes and goes, in other words the rhythmical disruption is not constantly present.

 

Treatment and prevention

The treatment for heart flutter varies, depending on how long it has been present. If the heart flutter has only started recently, the patient should be sent to hospital straight away. If it has been present for a day or two, treatment at the hospital will soon be able to get the heart beating normally again. This is done by sending a current through the heart, which is known as electroconversion. Patients who are given this treatment are first anaesthetised. If heart flutter comes and goes, there are techniques that can get the heart’s chambers to beat normally again.

One technique that can be used it to pinch the nose and keep the mouth shut while forcing air from the lungs (the Valsalva manoeuvre). Others may benefit from prompting the gagging reflex. Another trick is to massage the veins in the neck, known as carotid massage. If the heart flutter has persisted for longer than two days, it will be necessary to thin the blood before electroconversion can be done. The patient is then given blood-thinning medicines for two to three weeks, before returning to the hospital for treatment. The reason for this is the need to be sure that there are no blood clots in the heart when giving treatment with electricity. If heart flutter has been present for a long time, electroconversion will not help because it will quickly come back. For these patients, the appropriate treatment is medication to restore a normal pulse and blood-thinning treatment. A method that is commonly used in the treatment of atrial fibrillation is ablation therapy. This is a procedure that involves introducing electrodes inside the heart in an attempt to locate the electrical circuits that have caused the chaos and destroy them. This can be an effective treatment, though relapse is common, and the treatment is very resource-intensive.  A lot of patients with heart flutter also have heart failure. Treating these patients is challenging, and assessment and treatment by a heart specialist will often be required.

 

Investigation and diagnosis

Heart flutter produces a distinctive ECG reading.

ECG (electrocardiogram) is a method for measuring the heart’s electrical activity. A doctor will soon be able to see whether heart flutter is present if an ECG is taken while the patient is having symptoms. Even before an ECG is taken, a doctor will often suspect heart flutter from the patient’s reported symptoms. The doctor will also conduct an examination, including measuring blood pressure and pulse, listening to the heart and lungs, checking for distinct blood vessels in the neck and for swollen legs.

 

Causes of heart flutter

 

Heart flutter (atrial fibrillation) can have a number of causes.

The most common is heart disease as a result of either high blood pressure or damage to the heart and the heart valves. Heart flutter often comes on following angina or myocardial infarction. Other factors, such as low metabolism, being overweight with obesity and diabetes also lead to an increased likelihood of heart flutter. This is also the case for patients with lung diseases such as COPD. Alcohol is a known heart toxin, and high consumption can also lead to heart flutter – also known as “Monday heart attacks”. In close to 30 percent of cases the doctor is unable to find any clear and definite cause. In recent years, a lot of attention has been focussed on heart flutter in 40-50 year-olds who take part in endurance events such as marathons. There is some uncertainty as to why fairly young people who do a lot of fitness training experience heart flutter, but it is thought that large volumes of blood in the heart can push against the walls in the front chamber and create disorder in the circuits, resulting in heart flutter. People with otherwise healthy hearts can also get transient heart flutter.

With chronic heart flutter, the cause is often some other disease.

 

Prognosis for heart flutter

The prognosis depends on whether or not the heart flutter is transient.

With transient heart flutter, the prognosis is good, and it often goes away by itself. If the heart flutter is the result of some other disease, it can disappear once the cause has been treated. Persistent heart flutter is often a condition that has to be lived with. If left untreated, it leads to an increased risk of blood clots and stroke. Treatment with blood-thinning medicines leads to some risk of bleeding.

 

Facts about heart flutter

  • With heart flutter, there are rapid and irregular contractions of the front chambers of the heart.
  • Heart flutter usually causes agitation/discomfort in the chest, palpitations, laboured breathing and tiredness, though often there are no symptoms. ECG is used to make a secure diagnosis.
  • Various treatments are available, depending on the cause of the heart flutter.
  • If left untreated, heart flutter leads to an increased risk of blood clots.