Some people have an irregular, and often rapid, heartbeat (known as Atrial Fibrillation), which makes them more likely to experience a stroke. This condition is often associated with other diseases that affect the heart, such as high blood pressure, coronary artery disease, abnormal heart valves or a heart that doesn’t function properly. (1)

How common is an irregular heart beat?

Around 1 in every 200 people worldwide has a heart that does not beat at a steady, normal pace. It is more common in elderly people, females, and those who are overweight or have a family history of heart conditions. It is estimated that 25% of individuals aged 40 and over will develop this condition during their lifetime. (1) The Burden of Stroke Report suggests that the total number of people affected will rise to 17.9 million by 2060. (2)

What are the symptoms of an irregular heartbeat?

Some people don’t have any symptoms and are unaware of their condition until it is revealed during a physical examination. Others may experience heart palpitations (such as pounding or fluttering), shortness of breath, chest pain, extreme tiredness, general weakness, dizziness and confusion. (3, 4)

What causes an irregular heartbeat?

A heart that doesn’t beat as it should can be caused by several factors. It may simply be a result of old age; increased stress; (5) smoking; or excessive alcohol/caffeine consumption. Some pre-existing conditions are also associated with Atrial Fibrillation, including high blood pressure; sleep apnoea (when you stop breathing in sleep); acute infections (such a pneumonia); thyroid problems; or heart disease, damage or failure. (3, 5, 6, 7)

How can this lead to a stroke?

When the two upper chambers of the heart (atria) are out of sync with the two lower chambers (ventricles), this causes an irregular heartbeat (Atrial Fibrillation) which can lead to blood clots. These clots can travel to the blood vessels in the brain, causing stroke. (8) An abnormal heartbeat is estimated to make someone 3–5 times more likely to have a stroke. It is also associated with more severe strokes, leading to a higher chance of death and disability. (2)

How is an irregular heartbeat diagnosed and treated?

Sensors are attached to the skin to check the heart’s rhythm and electrical activity. This is called an electrocardiogram (ECG). If an irregular heartbeat is detected, you will be prescribed medications and other interventions to try to alter its pattern. (1, 8)

If you have been experiencing problems for more than 24 hours, the risk of stroke is greater, and you may be given a blood-thinning drug, such as warfarin. These drugs stop the blood from forming clots and travelling to the brain, leading to stroke. (1, 8)

Can an irregular heartbeat be prevented?

Oral anticoagulant therapy (taking anti-bloodclotting drugs by mouth) is now recommended as the most effective therapy for preventing a stroke due to AF. In fact, they can reduce the risk by two thirds or even more. These include Vitamin K antagonists (VKAs), which affect how the liver uses vitamin K to regulate blood clotting, and Non-Vitamin K antagonists (NOACs) which work in a different way to prevent blood clotting (9).

As well as taking anticoagulant medicine, you can reduce the chance of developing an irregular heartbeat, which is a known risk factor for stroke, by leading a healthy lifestyle. This includes eating a good diet with plenty of fruit and vegetables, getting at least 30 minutes of exercise a day, and reducing caffeine, alcohol and stress. (3)

References:

1. [Guideline] January CT, Wann LS, Alpert JS, et al, for the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC/HRS guideline 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 Heart Rhythm Society. J Am Coll Cardiol. 2014 Dec 2. 64 (21):e1-76

2. https://www.strokeeurope.eu/downloads/TheBurdenOfStrokeInEuropeReport.pdf

3. Ferrari R, Bertini M, Blomstrom-Lundqvist C, et al. An update on atrial fibrillation in 2014: from pathophysiology to treatment. Int J Cardiol. 2016 Jan 15. 203:22-9.

4. https://www.world-stroke.org/images/atrial_fibrillation_PS_web.pdf

5. Kirchhof P, Benussi S, Kotecha D, et al. 2016. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European Heart Journal 37(38):2893-962

6. Mozaffarian D, Benjamin EJ, Go AS, et al, for the Writing Group Members, American Heart Association Statistics Committee., et al. Executive summary: heart disease and stroke statistics–2016 update: a report from the American Heart Association. Circulation. 2016 Jan 26. 133 (4):447-54.

7. Lloyd-Jones DM, Wang TJ, Leip EP, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. 2004 Aug 31. 110 (9):1042-6.

8. https://www.stroke.org.uk/resources/atrial-fibrillation-af-and-stroke?gclid=CjwKCAjwkYDbBRB6EiwAR0T_-nqY4WUM0ADdzhQq6GBKGn1Pvu6opS1hzVQrf_2nrc3-4mi0nvI1aBoC_34QAvD_BwE

9. AF association, SAFE et al. Oral Anticoagulant Therapy Booklet https://www.heartrhythmalliance.org/afa/uk/booklets

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