Contents
Most often, atrial fibrillation does not hurt. However, it almost fivefold increases the risk of a stroke, and at the same time reduces the chances of surviving it twice.
Half a million Poles suffer from atrial fibrillation. It is as if, for example, the whole of Poznań fell ill. Statistics show that many of them will surely get a stroke. Worse still, one in four will die immediately after a stroke, and one in two within a year of its occurrence.
Heart rate rhythm
The heart produces the electrical impulses needed to cause contractions that continually pump blood. The pulse spreads throughout the heart, causing contraction and relaxation that repeats cyclically at a frequency of 60-80 beats per minute. During sleep, the frequency is lower and amounts to 40-60, and during exercise it increases to 90-180 beats per minute.
In the case of atrial fibrillation, as a result of impulse disturbance, up to 400-600 vibrations per minute can be achieved. The work of the heart is disturbed, so the blood is not pumped at the right pace, and its retention promotes the coagulation processes. Such a clot can block blood flow to the brain and thus cause a stroke.
The causes of atrial fibrillation
It is not known exactly why atrial fibrillation occurs. It is favored by hypertension, diabetes, heart failure, hyperthyroidism and heavy drinking of alcohol. The patient most often experiences an unpleasant palpitations, is short of breath, feels anxious and may even lose consciousness. However, atrial fibrillation can also occur with a too slow or even normal heart rhythm. – That is why 1/3 of patients do not feel that they have arrhythmia. So if we feel palpitations, it is worth visiting your family doctor or cardiologist. The basic tests are to auscultate the heart, measure the pulse and ECG – says Dr. Piotr Abramczyk from the Department and Clinic of Internal Diseases, Hypertension and Angiology at the Medical University of Warsaw. Early diagnosis of the disease allows for the initiation of stroke prevention. Home pressure measuring devices that detect arrhythmia are now available. However, they are expensive. They cost about PLN 300.
A thrombus in the heart
As a result of atrial fibrillation, a blood clot can form in the heart which breaks off and travels through the bloodstream. When the blood supply to the brain is blocked, it causes an ischemic stroke. The hypoxic parts of the brain die and, as a consequence, the patient may lose the use of limbs, the ability to coordinate movements, stop speaking or see, and also lose the ability to understand speech. 65% of stroke patients require assistance with walking, 29% with food, and only 7% can use the toilet without special amenities.
When a patient is diagnosed with atrial fibrillation, stroke prevention is started and an attempt is made to restore normal heart rhythm. This is done with drugs or electrical stimulation of the heart muscle.
As a prevention of stroke, patients are given anticoagulant medication. They stop blood clots from forming. However, due to the fact that they disrupt the blood clotting process, they can be dangerous, because patients taking these substances, e.g. in the event of an injury, may bleed out. Therefore, their intake must take place under medical supervision.
Anticoagulants
However, the best way to prevent stroke in people with AF is still the administration of oral anticoagulants. So far, only preparations that are antagonists of vitamin K responsible for blood clotting have been available. They require careful supervision during therapy. – To determine the dosage of the drug, the clotting time of the blood must be determined at least once a month. Depending on this, the dosage is determined. Too little means no stroke protection, too much risk of bleeding. Patients therefore have to come to the doctor to get a referral and be able to have their blood tested. They wait a few hours for the result or get it on the next day. With the result, they have to go back to the doctor who will choose the dose of the drug. There are also devices for self-determination of blood clotting time. Their disadvantage is the price – about 2. zloty. In addition, one test strip costs PLN 18 – explains Dr. Piotr Abramczyk. He also adds that in the treatment with these drugs, even a slight change in the composition of the food can significantly affect their effectiveness. For example, all green vegetables containing vitamin K interfere with their action. The efficacy of this therapy is also influenced by other medications taken concomitantly; on the other hand, the need for frequent clotting index measurements allows the physician to closely monitor the patient and assess the effectiveness of the treatment. The results of the blood test clearly indicate whether the person is taking the prescribed drug or not.
Prevention of stroke
Two new drugs have appeared on the market that work slightly different than the existing ones. Their use does not require continuous blood tests and clotting time determination. The dose of the drug in most patients is constant and does not need to be changed. However, the doctor is not able to assess the effectiveness of the treatment, or readily available methods of checking how the patient has been taking the drug recently. The new drugs are just as effective and a bit safer for bleeding. They are also less prone to interactions with other medications. However, they have the disadvantage that in the event of sudden bleeding, you cannot give an antidote to counteract the effect of the drug. You have to wait for the drug to stop working. Older medications can be counteracted immediately. Unfortunately, new drugs are also not reimbursed. Monthly therapy costs over PLN 100. The problem is that these are preparations that are used chronically, not once, so it is a big expense for patients every year.
The Brain Stroke Foundation operating in Poland strives for better access of patients to modern therapies. She was involved in the creation of the Global Charter of Patients’ Rights with Atrial Fibrillation. – Stroke due to atrial fibrillation is particularly severe and handicapped, meaning that these patients are less likely to recover from it, and half of them die in the first year after it occurs. Stroke prevention is particularly important in Poland, where we have an alarmingly few stroke treatment centers, and the patient has to wait even several months for rehabilitation after a stroke and is rehabilitated far too short and too little intensively – says the vice president of the Foundation, Adam Siger.
Text: Halina Pilonis