Living With A-FIB How One Man Copes With A Not-so-rare Heart Condition
Posted on Wednesday, November 19, 2008
THE COLORS CREW — City employees are always busy on holidays, putting the American Flags in the downtown area and then retiring them at the end of the holiday. Taking down the flags from Veteran’s Day were Larry Stidham, l, and Earnest Wells.
The human heart is a remarkable machine, operating without any oil or grease lubricants, beating at an average rate of 72 times per minute and each beat pumps about 70 milliliters or blood, about 2. 37 fluid ounces. If we calculate this to a minute basis, 72 beats pumps about 1. 29 gallons per minute. For an hour, 4, 320 heart beats pump 77. 4 gallons per hour. For a day, 103, 680 beats pump 1, 858 gallons. For a year, 37, 843, 200 beats pump 678, 024 gallons. For a lifetime of 74 years, 2, 800, 396, 800 beats pump 4, 746, 168 gallons. Those are amazing numbers. All without oil or grease, no bearings to replace, no seals and no drive belts. All things considered, the heart is a marvelous machine. But things can go wrong. We may have a valve that needs repair, we may have the walls of the arteries “ coated with plaque”, we may have a coronary attack or we may have something go wrong with the control system resulting in a condition known as “ atrial fibrillation ” or A-FIB for short. The last is something that happened to me last Thursday, which is why you are getting such a drab article this time rather than something interesting. To explain A-FIB, I need to explain the anatomy of the heart and its normal activities, to make sure that we are all on the same page.
The Blood Path The heart is made up of four chambers, two atria (singular is atrium ) or upper chambers and two ventricles or lower chambers. Each atrium is stacked on top of its respective ventricle, establishing a definite right and a left side flow path to the heart. The blood returning to the heart for re-circulation flows through the vena cava into the right atrium. From there it is pumped by the muscular contraction into the right ventricle which pumps it to the lungs via the pulmonary arteries. In the lungs, the blood loses carbon dioxide and takes up oxygen and thus purified blood returns to the heart via the pulmonary veins and enters the left atrium which pumps it into the left ventricle which has very thick muscular walls. The left ventricle pumps blood out of the heart through the aorta which immediately branches into the coronary artery carrying blood to the muscles of the heart itself, into the carotid arteries carrying blood to the head and brain and into other arteries carrying blood to all other parts. For our purposes, the coronary and carotid arteries will be the focus points. The left ventricle pump action is what determines our blood pressure. You can see that there are two complete and separate paths for blood through the heart, each having a muscular atrium and a heavier muscular ventricle. In the right atrium is located a small but very special bit of heart muscle called the sino-atrial node which initiates and sends the contraction impulse in three directions; one is to the rest of the muscle of the right atrium, another is to the muscles of the left atrium which means that the right and left atria contract simultaneously and the third is to a second area of nodal tissue called the atrioventricular node that, after a delay of 100 milliseconds, sends out the contraction impulse to both right and left ventricles which contract simultaneously. The atrial contraction completely empties both atria into the ventricles and their contraction completely empties the ventricles into the blood vessels. This is the normal anatomy and activity of the heart system. Sometimes the system described fails because the impulses generated by the sino-atrial node seem to be “ ricocheting ” around in the right atrium and possibly stimulating other nodal tissue to generate new contraction impulses so that the atria now may be trying to contract 250-450 times per minute instead of the normal 70-72. As a result, the blood passage through the atria is slowed, the amount of blood available to be pumped by the ventricles is less and the body cells have less oxygen to support body activities. The net result is you feel tired, have a rapid pulse rate, have an irregular pulse rate, are short of breath, dizzy or faint, or at least some combination of these symptoms. These are danger warnings that something may be wrong and that you could have A-FIB. I have visited the A-FIB state now either nine or ten times in the last eight years. Last Thursday I recognized the state due to shortness of breath, exhausted condition and irregular pulse rate which I verified with a home heart monitor. As I know that I was not in immediate danger, I went to bed and checked into the hospital Friday to get the problem resolved.
A-FIB Dangers The danger from A-FIB is that slow movement of blood through the atria leads to “ stagnant ” pooling of the blood and can lead to clots forming in the atria from which they subsequently enter the ventricles and can be pumped out in the arteries. If they are formed in the right atrium, they can be pumped out into the lungs and cause you partial loss of lung function. If the clots are formed in the left atrium they are pumped out in the aorta and some of them can enter and clog the coronary artery, resulting in a “ massive coronary ” or heart attack and possibly a very quick death. If the clots enter the carotid artery they can lodge in some small artery in the brain and prevent oxygen from reaching that part of the brain, thus cause a “ stroke”, which could range from a mild stroke, causing some damage, to a massive stroke causing death in only a few minutes. What can you do ?? Any time you are experiencing a combination of the symptoms listed above see your doctor for a checkup and ask about A-FIB. I believe most of the people experiencing strokes have gone through the A-FIB state without knowing it and so the stroke “ hit them without warning”. In fact, they probably had warnings which they did not have the knowledge to recognize. If you find you have AFIB, what can you do ?? Follow your doctor’s advice !! What will probably happen first is that they will give you a “ PT ” test, which is an index value related to your blood clotting time, and, based on the result, place you on some specific drug that lay persons call a “ blood thinner”. It is not a blood thinner, but is a chemical that specifically interferes with the chemistry of the blood clotting process inside your blood vessels. Your blood is not thinned but its ability to form clots is impaired. Probably the most common drug prescribed is “ Coumadin”, which is a polite name used for a mouse and rat killing poison first marketed as “ Warfarin ” or “ D-Con”. Your PT value will be determined probably every week until it is of an appropriate value. After your “ PT time ” is at the desired level and relatively stable, then your doctor or cardiologist will see about restoring you to a normal sinous rhythm either by certain drugs or by shocking you under anesthesia (it’s called electrocardioversion ). Once you are in normal sinous rhythm your blood will be tested probably once every month to make sure your “ PT ” is such that even if you revert to A-FIB your chance of having a stroke or coronary is about zero.
What Causes A-FIB Because the foods you eat have different amounts of Vitamin K which is an important factor in accelerating your blood clotting process, you may be advised to limit your intake of those foods because they will affect your PT. In my case, I love turnip greens and mustard greens which have high Vitamin K content but limit my intake to only one or two servings out of the 14 potential meals per week. What causes A-FIB ? I have asked this of several doctors. One says possibly heavy caffeine use. Another, possibly heavy nicotine use or other alkaloid use. Another, possibly high levels of stress. I have a booklet from Pfizer, Inc. that states, “ Your symptoms may occur: After you drink alcohol, After you eat certain foods, After you participate in certain activities, but AF can also occur without any reason that you might notice. ” In other words, no one really knows. Now you know why I was not in an emergency rush to the hospital, I knew that my PT value was exactly in the middle between the dangerous and the no danger state. Doctors tend to get upset when they discover you are in A-FIB and have a fast blood clotting time. Upon my first trip into AFIB, my family doctor, upon reading the PT value of my blood, came rushing into the exam room and said in a rapid and excited voice, “ We have got to get you on Coumadin immediately for you are a STROKE JUST WAITING AROUND TO HAPPEN !!” I was ignorant of A-FIB then. If you are in AFIB and do not know it, you are in danger of a stroke or a coronary. Editor’s Note: Dr. Lane, who lives at rural Gravette, is a retired professor from the University of Arkansas Department of Biological Sciences.
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