Getting to the heart of the matter on stroke

A silent killer is stalking many families across Australia, taking victims with little notice while driving a black-hole in the country’s health budget. But a simple pulse check may be enough to detect this harmful and costly condition.

Every year, as many as three million people across the world will have a stroke attributable to abnormal heartbeats called atrial fibrillation. This is equivalent to one person every ten seconds.

Atrial fibrillation is the most common abnormal heartbeat that affects almost 400,000 Australians, and it can produce potentially lethal clots that are responsible for one in six strokes.

Stroke is usually rapid in onset and devastating for individuals and their families. It often leaves the sufferer with physical disability and impairment. In Australia, it’s the second biggest cause of death after heart disease.

The National Stroke Foundation estimates that approximately 53,000 people are affected by stroke each year, at the cost of A$1.3bn. But beyond the financial impact is the direct effect on the workforce and communities, hard-hit with the loss of productivity and loved ones.

But many strokes can be prevented if symptoms are recognised and help for getting the appropriate treatment is sought.

What is atrial fibrillation?

Atrial fibrillation occurs when chaotic and disorganised electrical activity replaces the regular pace of the heart in the upper chambers (atria). This stops the atria from beating in a regular rhythm and the heart’s efficiency to pump blood is reduced. This can cause clotting (stasis) of the blood in the upper chambers of the heart.

When the heart does provide an effective pump of blood again, the clot may be passed from the heart via the blood vessels to the brain causing a stroke.

Atrial Fibrillation, Clot Formation and Stroke

The risk of stroke is thought to be five or six times greater in patients with atrial fibrillation compared to those with a normal heart rhythm. In addition, the burden from atrial fibrillation is set to increase at least threefold by 2050 as the population ages and cardiovascular disease remains common.

Risk factors and causes

Atrial fibrillation is more prevalent in the elderly, male Caucasian population. Well-established risk factors include heart failure, disease of the heart valves, heart attacks, high blood pressure, diabetes and sleep apnoea.

Lifestyle factors including smoking, excessive alcohol intake and caffeine consumption, combined with obesity and elevated stress levels increase risk. There’s also a growing body of evidence suggesting that avoiding consuming energy drinks, with their high levels of caffeine, and excessive sport can reduce an individual’s risk.

Signs and symptoms

The signs and symptoms of atrial fibrillation vary and it’s often very difficult to diagnose because of its silent nature and vague set of symptoms. The symptoms may include palpitations, shortness of breath (dysponea), chest pains, low blood pressure (hypotension), reduced ability to participate in exercise, fatigue, general malaise, dizziness and light-headedness, panic attacks, fainting (syncope) and a tendency to produce lots of urine (polyuria).

Having a health professional manually check your pulse remains one of the quickest and most reliable ways of checking for irregularity of your heart rate and rhythm. If an irregular heartbeat is suspected, an ECG can be performed to trace the heartbeat and assist clinicians in diagnosis.

Treatments

There are many treatments available for atrial fibrillation to reduce the risk of stroke. These include defibrillation (electrical cardioversion) or invasive procedures such as catheter ablation (when a series of thin, flexible wires are put into a blood vessel in and guided into your heart through that blood vessel to restore order to the electrical pathways in the heart), blood thinning medications and medications to correct the rhythm and rate of the heart.

Current advances in therapies include newer blood thinning medications and implantable devices.