Prevent irregular heartbeats to prevent stroke

Irregular rhythm of the heart has the potential to cause further complications, like stroke. Experts in this report by SADE OGUNTOLA, advise ageing adults and those at higher risk of irregular heartbeats to learn about the condition and associated risks.

Atrial fibrillation, an irregular often rapid heartbeat is often the result of some emotional or physical stress. It may also happen due to hormonal triggers.

But atrial fibrillation, which often comes as palpitations, irregular pulse, shortness of breath, fatigue, pain in the chest and dizziness, can increase the risk of stroke by almost five times.

Ironically, cases of abnormal rate or rhythm of the heart are under-reported and are an unrecognised risk factor for stroke in Nigeria, like many other sub-Sahara African countries.

A shockingly high number of people are diagnosed with atrial fibrillation every year and a larger number still are estimated to be living with the condition undetected.

“You will find more people with atrial fibrillation when you visit a hospital  such as University College Hospital (UCH), Ibadan, and most of them have developed its complications,” said Dr Abiodun Adeoye, a consultant cardiologist at the UCH, Ibadan.

Dr Adeoye said most of these people are unaware of the condition since it gives no signs or symptoms.

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“Cases of atrial fibrillation is underreported in studies by researchers even though more and more people are coming down with stroke, heart failure and all that,” he noted.

A normal heart rate should be regular and between 60 and 100 beats a minute when resting. The heart rate can be measured by feeling the pulse on the neck or wrist.

Dr Adeoye added: “You can check the pulse on your hand to know if it is regular or not. It is not all irregular pulses that are due to atrial fibrillation. But if one has an irregular pulse, the chances of having atrial fibrillation are higher than in someone with a normal heart rate.”

In atrial fibrillation, the heart rate is irregular and can sometimes be very fast, in some cases higher than 100 beats a minute.

It is the most common heart rhythm disturbance. It can affect adults of any age, but it’s more common in older people. It affects about seven in 100 people aged over 65.

This is unlike heart palpitations, where individuals may be aware of noticeable heart palpitations, where the heart feels like its pounding, fluttering or beating irregularly, often for a few seconds or, in some cases, a few minutes.

Sadly, these abnormal heart rhythms are sometimes associated with hypertension, cardiomyopathy, also called heart muscle disease, and rheumatic heart disease in sub-Sahara Africa.

Experts’ review of studies on atrial fibrillation in sub-Sahara Africa that described subpopulations of stroke patients showed an atrial fibrillation prevalence ranging from 1.5 per cent to 17.6 per cent- which was much lower than expected based on the knowledge that 20 per cent to 30 per cent of all strokes are due to atrial fibrillation.

This 2109 review in the Journal of Cardiovascular Electrophysiology indicated that prevalence increased with age from 0.46 per cent in people aged 70 to 74 years up to 1.3 per cent to those age 85 years and older. Its incidence was different between men (0.31 per cent) and women (0.96 per cent).

Complications of atrial fibrillation included heart failure in about two thirds and stroke in 10 per cent to 15 per cent of cases. It is also associated with an increased risk of dementia and chronic kidney disease.

Now, the review indicated that in patients with known heart disease presenting at the hospital, the prevalence of atrial fibrillation varied from 3.8 per cent to 59.0 per cent.

In heart failure patients, the prevalence of atrial fibrillation was higher and ranged from 15.7 per cent up to 34.0 per cent.

Stroke patients, including those that have had a history of stroke, had an atrial fibrillation prevalence of 1.5 per cent to 17.6 per cent. Patients with rheumatic heart disease (RHD) had an atrial fibrillation prevalence of 13.9 per cent to 44.5 per cent.

Currently, hypertension was the most frequently reported stroke risk factor, with prevalence of at least around 60 per cent to 70 per cent for all studies.

Also, the prevalence of hypertension seemed higher in the stroke sub-population with a range of 31.0 per cent to 93.8 per cent, and it was lowest in rheumatic heart disease patients ranging from 5.2 per cent to 53.3 per cent.

Moreover, the review indicated that atrial fibrillation patients in Africa are in general younger than those in high-income countries. Also, stroke also tends to occur at an earlier age in the African population when compared with the age of occurrence in high-income countries.

In a SIREN (Stroke Investigative Research and Educational Network) study, a case-control study carried out in Ghana and Nigeria that aimed to identify and characterise stroke risk factors in sub-Sahara Africa, 68 per cent of the cases had ischemic stroke.

Professor Mayowa Owolabi, one of the SIREN investigators, described atrial fibrillation as ‘an irregularly irregular heartbeat that usually comes from the atrium, the small chamber of the heart.’

Professor Owolabi said: “If the impulses that make the heart to beat, which are coming from the atrium are irregularly irregular and are extremely fast, the heart will not beat well.

“And if the heart does not beat well, blood can pool and a clot can form inside the heart. If those clots dislodge or break off, it can be pumped by the heart to various vessels. This can block them.

“If it is the blood circulation in the brain that is blocked by a clot, this can cause a stroke. Basically, the chances of having atrial fibrillation increase with age as well as high blood pressure.”

Owolabi, a neurologist, however, said most times even medical experts do not rule out atrial fibrillation as a cause of stroke.

“What people think about when there is stroke is maybe hypertension, diabetes, abnormal cholesterol level, excessive intake of alcohol or even smoking. Very few people try to find out if their stroke is due to the irregularly irregular heartbeat. That is the issue,” he added.

Although such things as a bad diet, sedentary lifestyle, use of alcohol and smoking are common risk factors for stroke, Professor Owolabi stated that with advancing age, atrial fibrillation becomes also a risk factor for stroke that needs to be investigated by electrocardiogram (ECG).

An ECG records the electrical activity of the heart at rest. It provides information about the heart rate and rhythm and shows if there is enlargement of the heart due to high blood pressure or evidence of a previous heart attack.

The expert declared that with Nigeria’s increasing life expectancy and ageing population, the frequency of atrial fibrillation is bound to increase.

Owolabi added: “It atrial fibrillation is an important risk factor for stroke, and an interesting part of this is that can be treated with medications that regulate heartbeat.

“Also, individuals who have atrial fibrillation can take medications to prevent clots from forming in their heart. If a clot does not form in the heart, then it will not cause a stroke.”

So, it’s important to maintain general wellness, stay on track with routine check-ups, and keep atrial fibrillation and stroke risk in mind with advancing age.

Nigerian Tribune