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NEW HANOVER REGIONAL MEDICAL CENTER

Taking Control of Atrial

AFIB Patient Guide-2019-CVR-1-4PRINT.indd 3 6/14/19 11:01 AM Leading Our Community to Outstanding Health

AFIB Patient Guide-2019-CVR-1-4PRINT.indd 4 6/14/19 11:01 AM Taking Control of Atrial Fibrillation

Getting Back on the Beat: Taking Control of Atrial Fibrillation

What is Atrial Fibrillation? ...... 2

Cause of Atrial Fibrillation? ...... 3

What are the Risk Factors for Developing Atrial Fibrillation? ...... 3

Types of Atrial Fibrillation? ...... 4

What are the Symptoms of Atrial Fibrillation? ...... 4

How is Atrial Fibrillation Diagnosed? ...... 5

Atrial Fibrillation and ...... 7

Treatment Strategies ...... 9

Related Medical Conditions ...... 11

Lifestyle Changes ...... 11

When to Call for Help ...... 12

My Atrial Fibrillation Action Plan ...... 13 My Important Numbers ...... 13

Understanding Afib and Stroke Risk ...... 14

Understanding My Afib ...... 15

Notes ...... 16

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What is Atrial Fibrillation? Atrial fibrillation, also known as Afib, is an irregular, fast heartbeat that may cause symptoms like , fatigue, and . At least 2.7 million Americans are living with Afib.

What Happens During Afib? Normally, your heart contracts and relaxes to a regular beat. In atrial fibrillation, the upper chambers of the heart (the atria) beat irregularly (quiver). Because of this irregular beat, a blood clot can form. If the blood clot breaks and enters the bloodstream, it could go to the brain and cause a stroke. About 15-20% of people who have have this irregular heart rhythm. Patients with this condition are put on blood thinners to prevent strokes. Afib is a serious condition. If atrial fibrillation is not treated, it doubles the risk of heart-related death and increases the risk of having a stroke by five times.

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Cause of Atrial Fibrillation Causes of Afib can be put into two categories; factors that Sometimes, you can control and factors you can’t control. the causes of Afib can Afib Risk Factors be unclear and other times, people with normal You Can Control may develop • High cholesterol Afib. • High

• Heart disease

•

• Excess weight Afib Risk Factors • You Can’t Control • abuse • Family history • Lack of exercise • Advancing age • Some medications • Heart diseases from birth •

HOW TO REDUCE RISKS?

1 2 3 Improve Treat atrial Know your risk & your overall fibrillation and take risk-lowering health related conditions meds if needed

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Types of Atrial Fibrillation Paroxysmal Persistent Afib Afib Paroxysmal Afib – Afib that comes and goes. The episode may last for seconds, minutes, hours, or days before the heart returns to its normal rhythm. As the heart goes in and out of Afib, Atrial your heartbeat may change from slow to fast and back again in short Fibrillation periods of time. Persistent Afib – Afib that does not stop by itself. Medication or a procedure called is used to help the heart return to normal rhythm. If no treatment is done, the heart will stay in atrial fibrillation. Permanent Afib – Afib that cannot be corrected. Medications and procedures are not able to return the heart to normal rhythm. You will be given treatment to Permanent control your and reduce the risk of stroke. Afib

What Type of Afib Do I have?

Symptoms of Atrial Fibrillation The symptoms of Afib are different for each person. Some people can tell as soon as Afib begins. Other people don’t have any symptoms. 1. Feeling over tired or lacking energy (most common) 2. Having a fast heartbeat 3. Being short of breath 4. Racing or pounding heart 5. Struggling with everyday exercises or activities 6. Feeling pain, pressure, tightness, or discomfort in your chest 7. Feeling dizzy or lightheaded 8. Fainting

What are my Afib symptoms?

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How is Atrial Fibrillation Diagnosed? There are quite a few tests done when someone has a fast or irregular heartbeat. Your doctor may order one or more of these tests. Electrocardiogram (ECG) – An ECG is a snapshot of your heart’s electrical activity. It is often performed in a doctor’s office. Stickers (electrodes) are attached to your chest, arms and legs. This test measures the rate and rhythm of your heart. – A Holter monitor is a transportable ECG. It is typically worn for 24 to 48 hours. Stickers (electrodes) are placed on your chest and are then connected to a small recording machine. It records the electrical activity of your heart for your doctor to review later. Mobile Cardiac – A continuous event monitor that is like a Holter monitor but is worn for up to 30 days. It will trigger a recording when it feels an abnormal rhythm (). The results are automatically sent to your doctor, who uses this information to evaluate your symptoms and determine if they are caused by an abnormal heart rhythm. This type of monitor helps diagnose Afib in patients without symptoms or in patients who have Afib only occasionally. Implantable Loop Recorder – Implantable loop recorders (ILRs) continuously record the heart’s rate and rhythm. It is placed under the skin of the chest, and the battery lasts about three years. It transfers information about your heart’s rate and rhythm to your doctor. ILRs are most commonly used for patients who have an irregular heart rhythm occasionally.

Electrocardiogram (ECG) Holter monitor Implantable Loop Recorder

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Other Tests Your doctor may order other imaging tests. These tests can help your doctor choose the right treatment plan for you.

Echocardiogram – An echocardiogram uses sound waves to take pictures of your heart.

There are two types of echocardiograms:

Transthoracic Echocardiogram (TTE) – This type of echocardiogram gives your doctor a picture of your beating heart. It is non-invasive, which means nothing goes inside your body. A technician spreads gel on your chest and then moves a device, called a transducer, across your chest. A video then shows the size of your heart and how well your heart and heart valves are working.

Transesophageal Echocardiogram (TEE) – A transesophageal echocardiogram, or a TEE, shows a clearer picture of the top chambers of your heart. A probe, called a transducer, is inserted through your mouth and moved down your (the tube that connects your mouth to your stomach). You will be given medicine to help you relax, and spray is used to numb the back of your throat so you are comfortable during the procedure. This type of echocardiogram is used to get more detail about heart valves and to check for clots that may have formed in the heart.

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Atrial Fibrillation and Stroke One of the most serious risks of Afib is the risk of stroke. Afib makes the top chamber of the heart quiver so blood does not flow normally. With the blood moving more slowly, it can form clots. If a clot that forms in the left top chamber of your heart breaks free, it can travel out to your body. If a blood clot travels to the brain, it can cause a stroke. Your doctor will ask you about your medical history to figure out if your Afib increases your risk of having a stroke. If you are at increased risk for stroke, blood thinners are used to reduce your risk.

1. Blood clot can form during atrial fibrillation

2. Blood clot travels 3. Clot blocks an in in the bloodstream the brain, causing stroke

SPOT A STROKE F A S T FACE ARM SPEECH TIME DROOPING WEAKNESS DIFFICULTY TO CALL 911

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Treatment Strategies Treatment Strategies Overview There are several treatment options for Afib. You and your doctor will work together on a treatment plan. ü Cardioversion The goals of treatment for Afib are to: ü Catheter for Afib • Prevent stroke AV Nodal Ablation • Control heart rate ü • Return the heartbeat to a normal rhythm if being in ü Medication a normal rhythm makes you feel better or is needed to control your heart rates ü Lifestyle Changes • Reduce any triggers for Afib

Cardioversion If you go into Afib, your doctor may suggest a procedure called cardioversion as a treatment option. The cardioversion procedure involves an electrical current, or , to the heart muscle to restore the normal rhythm. It is a same-day procedure that takes minutes. Large patches (electrodes) will be placed on your chest and back. You will then be given sedation through an IV line to make sure you are comfortable. A timed electrical shock will pass through these electrodes to return your heart rhythm to normal.

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Catheter Ablation for Afib is a procedure that can be used to lessen triggers for Afib. The goal of this procedure is to reduce how often your Afib episodes happen as well as to decrease your Afib symptoms. You will be sedated and given a blood thinner to prevent clots from forming in your heart during the procedure. Thin, flexible wires called catheters are inserted into a vein in your groin and/or neck. These wires, or catheters, are threaded through the vein and into the heart. A special catheter, called an ablation catheter, will be used to block abnormal electrical signals from the pulmonary veins (tubes that bring blood from the lungs back to the left top chamber of the heart) which can trigger Afib. You will stay in the hospital overnight for observation after the procedure. Afib ablation is a safe procedure, but there are some risks: • Stroke

• Collection of blood around the heart ()

• Damage to the blood vessels in your groin area

• Narrowing of the veins coming from the lungs to the left ()

• Damage to a nerve that affects movement of your diaphragm (phrenic nerve palsy)

• Creation of an opening between the atria and the esophagus (atrio-esophageal ) AV Nodal Ablation A procedure called an AV nodal ablation can also be used to control your heart rates if medicines are not working. You will need to have a permanent electrical pacemaker placed before the AV nodal ablation and will remain in Afib after the procedure with the pacemaker controlling your heart rate

Managing Checking your Rate and risk factors stroke risk and Assess your TREATMENT Rhythm and lifestyle putting you on symptoms control changes blood thinner

DESIRED Clinical Decrease risk Stroke Symptom OUTCOME stability for Afib prevention improvement

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Medication Medication is a key part of treatment for Afib. If you have Afib, you may need to take one or more medicines for the rest of your life, such as: • Rate control medication – This type of medicine slows down a fast heart rate.

• Rhythm control medication (also called anti-arrhythmic drugs) – this type of medicine helps keep a normal heart rhythm.

• Blood thinners (also called ) – This helps prevent blood clots from forming.

Medications that keep your heart Medications that slow heart rates in a normal rhythm

Beta Blockers: tartrate (Pacerone) (Tambocor) (Lopressor), metoprolol succinate (Toprol Disopyramide (Norpace) (Rythmol SR) XL), propranolol (Inderal), carvedilol (Coreg), (Zebeta) (Tikosyn) (Quinate)

Calcium Channel Blockers: (Multaq) (Betapace) (Calan, Verelan), (Cardizem) (Lanoxin)

Please note the following: Whenever you are prescribed a medication, your medicine container will have the name of the medicine, dose, and instructions on how often to take the medicine. The pharmacist will also give you more detailed, printed instructions and a list of side effects to watch out for while using the medication(s). Everyone reacts differently to medication. You may need to try more than one medicine before you find what works best for you and has the fewest side effects. Once you find a drug that works, you may have Afib less often, it may be mild, and you may see a decrease in symptoms. However, you will likely experience Afib from time to time.

What medicine(s) am I on for Afib?

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Related Medical Conditions

People with Afib often have other medical conditions. If you have any of the conditions below, your doctor may prescribe additional treatments for you, as these conditions may add to the frequency and severity of your Afib.

High blood pressure ()— If you have high blood pressure and atrial fibrillation, it is very important to keep your blood pressure under control and eat a heart-healthy diet. High cholesterol—If you have high cholesterol, fatty material can build up in your and block the flow of your blood. When your arteries are clogged, your heart and other organs may not get the oxygen they need to work effectively. Your doctor may prescribe a medication called statins to lower your cholesterol to stop the buildup of fatty material in your arteries. Sleep apnea—People with Afib often have sleep apnea, a type of breathing sleep disorder. People with sleep apnea don’t get enough oxygen during sleep and may not be aware of how often they wake up during the night. Restless nights and fatigue are common symptoms. If you have sleep apnea, your doctor may prescribe a mask or a treatment, called a continuous positive airway pressure (CPAP) machine, to make sure you get normal amounts of oxygen while you sleep. Sleep apnea can lead to Afib or can make Afib worse.

Lifestyle Changes You can decrease your risk of getting other heart conditions that are related to Afib by changing your diet and exercising. Cut down on fat, especially saturated fats, so you can improve your cholesterol levels. Limit the amount of salt you use so you can lower blood pressure. Regular exercise—even walks around the block or light gardening— will make your heart and arteries healthier. (If you feel tired or short of breath, stop and rest. If you can’t hold a conversation during exercise, you’re pushing yourself too hard.) Eating better and staying active can help you reach a healthier weight, which is good for your overall health.

Alcohol and —You should avoid drinking too much alcohol or using recreational drugs (stimulants). Overuse of alcohol and stimulants can lead to Afib and stroke. Stop smoking—Quitting is the single most important thing you can do. It is important to stop smoking and avoid secondhand smoke. After quitting, your symptoms of cough, shortness of breath and wheezing will most likely improve. If you need help quitting, New Hanover Regional Medical Center offers a class to help you quit smoking. Call 910.264.9200 for more information and a schedule of classes. More information on quitting tobacco can also be found at:

• Smokefree.gov • quitnow.net

• quitlinenc.com • 1-800-quitnow

What lifestyle changes am I doing to help with my Afib?

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When to Call for Help A variety of could indicate you are having a heart attack or stroke and should call for help. Heart Attack A heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off. Early Signs - Call Your Doctor: • Mild , discomfort, pressure • Recurring pain/discomfort that occurs with activity but subsides at rest () • Shortness of breath with normal activity • Burning in the throat/chin that may imitate heartburn or indigestion

Signs and Symptoms - Call 911: • Uncomfortable pressure, tightness, fullness or squeezing in the chest • Pain in the center of the chest lasting more than a few minutes • Pain spreading to the shoulders, neck, back, jaw or arms • • Nausea/vomiting • Fainting • Sweating • Difficulty breathing (tear out) Heart attack symptoms may differ for women: As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are more likely to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain. You may experience any or all of these symptoms. The faster you get help, the greater the chance of limiting damage to your heart and recovering.

Stroke Call Face drooping: Does one side of the face droop or is it numb? Ask the person to smile. 911 if you Arm weakness: Is one arm weak or numb? Ask the person to raise both arms. experience any Does one arm drift downward? of the listed signs of a Speech difficulty: Is speech slurred, are they unable to speak, or are they hard to stroke understand? Ask the person to repeat a simple sentence, like “the sky is blue.” Is the sentence repeated correctly?

Time to call 911: If the person shows any of these symptoms, even if the symptoms go away, call 911 and get them to the hospital immediately.

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My Atrial Fibrillation Action Plan Use this sheet to help create an action plan with your provider. This will help guide you about when you need to seek help for your Afib.

• Afib Symptoms:

• Stroke Symptoms:

• Heart Rate:

• Symptoms (serious):

Call your healthcare professional immediately if you have the following symptoms:

Call your healthcare professional or the Afib clinic the next business day if you have the following

symptoms: (tear out)

My important phone numbers are:

Primary Care Doctor:

Phone #:

Cardiologist

Phone #:

Pharmacy:

Phone #:

Other Healthcare Provider:

Phone#:

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Understanding Afib and Stroke Risk A CHA2DS2-VASC score, named for the different categories that make up the score, calculates stroke risk in patients with atrial fibrillation. If you answer yes“ ” to the questions below, add the points for that caterogry to your score. According to the American Heart Association (AHA), a 1 Point Congestive CHA2DS2-VASC C Do you have Congestive Heart Failure? score of 2 or greater increases the risk of stroke 1 Point Hypertension by as much as 5 H Do you have high blood pressure? times.

Age 2 Points A2 Are you 75 years old or older? Talk to your healthcare 1 Point provider if your D Do you have diabetes? score is 1 or higher. (tear out) Stroke 2 Points S2 Have you had a stroke?

Vascular Disease 1 Point Do you have a history of heart attacks, To reduce risk V peripheral artery disease or clogged arteries? of stroke, it is important to take your blood Age 1 Point thinners as A Are you between 65 and 74 years old? prescribed by your doctor.

Sex/Gender 1 Point What was your sex assigned at birth? SC (if female add a point)

Total your CHA2DS2-VASC score HERE

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Understanding My Afib *In what ways does Afib increase my health risks?

*Do I have health concerns that may increase my risks?

*What is my treatment plan for Afib?

*What should I expect throughout my treatment plan? (tear out)

*I will know I am making progress when…

*My exercise plan is…

*My diet plan is…

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2131 South 17th St., Wilmington, NC | 910.343.7000 | nhrmc.org

AFIB Patient Guide-2019-CVR-1-4PRINT.indd 5 6/14/19 11:01 AM New Hanover Regional Medical Center and its affiliates comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex. ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 910-667-7000. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 910-667-7000. 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 910-667-7000。

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