Symptoms of af

[JMannion]

My father has been diagnosed with AF but has no symptoms.  I just wanted to find out if over time will he get bad symptoms / episodes, and if so can medication control this?

[Hidden]

I wonder how old your father is? 

Many older people have AF and are completely unaware of it . This is where the problem can start. As you probably know there is a high risk of stroke if you are not properly anti coagulated . I assume that your father is either on Warfarin or one of the newer drugs such as Rivoraxaban.

My brother of 73 was diagnosed last year quite by chance when he was having a blood pressure check. He had no symptoms and only takes Rivoraxaban. He continues his normal activities, golf etc. He is not expecting to get any worse so he tells me ! And indeed he may not.

Yes. there are several drug treatments available including betablocker s. That reminds me....my brother also takes Bisoprolol  , a betablocker  , which slows his heart rate .

Sandra 

[JMannion]

Thank you, he is 69 years old.  He is not on a blood thinner yet as the doctor said to go away and think about it.  He was put on bisoprolol straightaway.  The doctor never mentioned anything about episodes or symptoms to us.  

[Hidden in reply to JMannion]

I would advise you to look on the AFA website and read the leaflets. books etc and approach your GP again .  You should be supplied with more information  particularly re anti coagulation . 

[JMannion in reply to Hidden]

Yes we are going back next week, also to get the results from his heart scan.  

[BobD Volunteer in reply to JMannion]

It really is vital that he is anticoagulated. As has been said above AF makes people five times more at risk of stroke even with no other factors.

Many people are asymptomatic (have no apparent awareness of their condition ) and those are the ones greatest at risk as they frequently only discover that they have AF as a result of a stroke. Your father is lucky as he has a chance to do something about it.

Please go to AF Association website and read up all you can and make sure that your doctor does something about it. There are other considerations as well regarding bleed risk which need to be considered, just in case he is one of very few people who should not have anticoagulation  Please don't be fobbed off with aspirin either as this is about as useful as a chocolate teapot where AF is concerned. If in doubt ask to see a specialist in stroke prevention who can do all the calculations.

Regarding symptoms in some respects he is lucky and can get on with the rest of his life  as he is not likely to suddenly become symptomatic. Most drug regimes are to improve quality of life so no need really in his case.

Please ask questions and we will try to inform you but remember AF Association where there is so much information.

[JMannion in reply to BobD]

Many thanks for your help.  I am trying to do as much research as possible before we see the doctor next week.

[RobertELee in reply to JMannion]

...go away and think about (anti-coagulation)?!!!    The doctor is supposed to do the thinking for your father.      It beggar's belief.

[Steve112 in reply to RobertELee]

And so the wheel turns.....myself my symptoms are asymptomatic.. it's very much luck of the draw with GP's/ cardiologist.....No referrals from my cardiologist just stay on Bisoporol for life with no follow up whatsoever.....a GP who refuses to refer me to a EP quoting "there is simply no need"...if the risks are what members are saying surely this must be addressed...we place ourselves and trust in the hands of the highly paid experts who in my experience haven't got a clue ...my wife nearly died from another very experienced 40 years served GP's assessment "don't worry dear it's just a virus"....which turned out to be colon cancer being so gravely ill needed to wait 2 weeks until they could operate on her..this is just one instance of incompetence and misdiagnosed illness  I have had in my 59 years of NHS doctors..if you have a good GP then treasure them....you are very lucky......

[tony85]

I have had AF with no symptoms but I must take anticoagulants.  

[PeterWh in reply to tony85]

Is this a question

"must I?"

[tony85 in reply to PeterWh]

You read the other posts and most seem to agree that if you have AF you should be on anti coags. Wafarin has been used for a long time with no serious side effects. It just needs careful management.  It reduces risk of stroke consiserably

[Hidden]

Hi JM, just a small but relevant point re anti-coagulation is that is does not thin the blood. The blood remains the same viscosity. The drugs just slow down the clotting process. Personally I find this important to know because it would worry me if I thought I was walking round with thinner blood than other people!!! I've been on AG's for about a decade and will continue forever, I'm 66. I'm a farmer, cut and bruised myself more times than I can remember and not had any problems. 

PS. I also play golf and I'm dreadful 😤, maybe that's because of the anti-coagulants? It can't possibly be me! 

Koll

[dave1950]

I think it is a bit harsh to be over critical of some GP's who are not rushing down the anti-coagulant route. I have a brilliant GP who is always up to date and have seen an EP as well so far who said the same. @ JMannion I thought I was reading a post about me!! I am similar age, play golf, don't feel too bad when I get it etc ! Put straight on bisoprolol after diagnosis. Seeing the cardiologist for the first time next week. I thought my daughter had written this under a pseudonym! My advice has also been go away and think about it and I am. I think the issue is that if as an individual you are a very low risk the reduction in risk is not as significant as if you are a high risk. Imagine you had a risk of 1 in a 1000. WIth AF it would become 1 in 200. If you were 1in 10 it would become 1 in 2. This is obviously hypothetical but you can see the difference which is why you have to bring in factors like lifestyle change etc.

Having said that it seems common sense to go on anti-coagulants as a better safe than sorry measure, especially if they are not putting you at risk of something else and I probably will.

[PeterWh in reply to dave1950]

Dave

In addition to Bob's comments below there are a number of additional facts that are important in relation to AF sufferers.

A very high percentage of the strokes suffered by AFers are severe or are killers.  In addition the highest % of strokes belongs to us merry AF sufferers.  Those strokes are contrary to popular belief NOT confined to the over 65s or over 70s.  Having seen the effects on a number of people from early 40s, 50s and 60s who have suffered strokes makes it an absolute no brainer to me to be anticoagulated.  One man lived for about 17 years totally paralysed from the neck down and he could only grunt (sometime after the stroke) and it was one sound for yes and another for no.  However his brain was 120% there and active as his sister said.  Living hell!!!

People should not only look on the AFA website but also the UK Stroke Association Website.

[Hidden in reply to PeterWh]

My mom had a stroke. She eventually came round which amazed us as she couldn't communicate at all. I asked if she had been able to understand us. She told us that she could hear and understand everything we said. She's long gone now, not of a stroke as it happens. 

[BobD Volunteer]

Dave the plain facts are that we are very bad in UK at anticoagulating at risk patients. It has been calculated that we could stop about 8000 strokes a year if all at risk patients were found and suitable anticoagulants prescribed.

Since this subject is a quality standard and guidelines for GPs are in place it does beggar belief  that some still behave in this way.

Ten years ago the link was not so well established and when I started my AF journey stroke risk was never mentioned but we are 2016 now.

[Hidden in reply to BobD]

I am in the USA, diagnosed 4 mo ago and placed on low dose sotalol which I hate, and low dose aspirin. I was not given option of other anticoag nor was cva discussed. After educating myself on this site and others( thankyou), I am getting second opinion,Ironic that cardiologist #2  has afib and I am going to ask him all the questions I was too uneducated to ask doc #1. I really appreciate all the availability of info and input from those of you that know what you are talking about💝

[Hidden in reply to Hidden]

Let us know how you get on Hoski. 

[dave1950]

I'm not disagreeing with what you and Peter are saying and it is true. Nevertheless I feel there is a somewhat alarmist attitude on here at times which is often the case on support groups and doesn't always reflect the overall view of the medical world. I sometimes come on here and feel I am one of the two million walking dead!

The biggest problem is population statistics. I have a friend who has smoked 40 cigarettes a day since he was 14 and has been a transient alcoholic since he was 40. He still drinks and smokes and is 71. He survived a brain haemorrhage at 50. Equally I know someone who had died of a heart attack at 50 with no health risks, and others who have been heavy smokers and drinkers who have died young. These are all in the mix to produce average figures so we should act wisely to reduce our risk factors. But a 5x increase in risk does not mean you have 5x more risk than the man next to you at the bus stop who does not have AF. Unfortunately we don't know what our actual risk is as an individual so we just make choices in life to minimise risks, one of them being taking ant-coagulants. 

Incidentally, I know it is not prevention, but how much  do anti-coagulants reduce t he risk by?

Thanks for your informative views,

Dave

[Beancounter Volunteer in reply to dave1950]

"But a 5x increase in risk does not mean you have 5x more risk than the man next to you at the bus stop who does not have AF."

Actually Dave yes it does if that person next to you is the same in every respect other than that of having AF. So if it was your twin brother and you had the same lifestyle etc etc, you would be at 5 times the risk.

Of course there are other factors for stroke, but the CHADS2VASC doesn't measure anything other that the stroke risk for having AF with other medical factors such as diabetes. And many of those other lifestyle factors, of which the main four, are diet, activity, smoking and drinking, still contain 5 times the risk if AF is added to your personal mix.

So if your stroke risk without AF and with your lifestyle was say 1%, the addition of AF would make it 5% If however you were super great at diet and exercise and a lifelong non smoker and drinker, your risk might be 0.2% increasing to 1% if you have AF.

(And those numbers are examples only, not meant to be actual risks which of course depend on many factors)

The other problem that many do not understand is that the risk is cumulative, so if you are 5% this year, you are 10% next year (not exactly correct but close enough for illustration)

Re the second question anticoagulants and risk reduction, I think (and am happy to be corrected) that it's just over half, so from 5 times to just over twice.

But I do agree with everything else you say about the extremes at either end of the "bell curve" that makes up our statistics.

Be well

Ian

[Hidden]

You are correct, I am on two afib facebook pages, which in general are very helpful but then I read posts about failed nightmare ablations etc and come away frightened. Guess they are more beneficial to me than harmful as Ive learned alot of valuable info

[cherylbyrd]

Your father should definitely be on an anti-coagulant - warfarin, Eliquis (apixoban), or other. My husband was unlucky enough to have a stroke because his Afib was not diagnosed, and blood clots formed in the heart to laterbbecome lodged in his carotid artery.  Fortunately he has recovered about 85% over the past two years.  Your dad should not need any other medications if he is not having symptoms.

[JMannion in reply to cherylbyrd]

Thank you, he has not got any symptoms but his doctor found on a routine check up that he has a irregular heart beat so he was put on a beta-blocker straightaway.

[PeterWh in reply to JMannion]

As you probably know a beta blocker slows the heart.  It has absolutely no benefit at all in stroke prevention.  The fact that he is symptomless is totally irrelevant!!!

[JonathanPittsCrick]

I agree with dave1950  that the need for anticoagulation is not that definite and the GP's advice was reasonable. If your father doesn't have any other risk factors apart from being over 65 he has a CHADSVASc score of 1. Gregory Lip (who devised the score) says [in Circulation. 2012; 126: 860-865] that for anticoagulation with warfarin, "There was a neutral net clinical benefit with ... CHA2DS2-VASc score of 1" . Expert groups recommend that with a score of 1 anticoagulation should be CONSIDERED depending on the wishes of the patient. There has never been a randomised controlled study of any anticoagulant in this situation and so no hard evidence of benefit. I have seen people with catastrophic bleeds on anticoagulation and people with disastrous strokes from AF without anticoagulation - there are dangers either way (and also with ablation treatment).

There is sadly no zero-risk option.

[Peter1955]

As others have said, he needs to be on ant coagulants. I am on Rivaroxaban, which seems fine and requires less monitoring.

I was a very fit 59 year old man when I got AF and at first it was asymptomatic, but I would get dizzy when rising from the sofa and once passed out momentarily, which triggered my wife's attention. I was in persistent AF. It began to impact seriously on my performance cycling and hill walking, as there was no power there. I clocked very erratic pulse, but up to about 215 if pushing hard.

Had cardio version in October, but it lasted only 4 days. Put on bisoprolol, it reduced pulse but left me with no energy, so I stopped it unilaterally after 2 weeks. (I can't recommend this, but that's what I did).

Had ablation in January and now getting back on track, thankfully.

Your father should not ignore AF just because there are no symptoms at present, they may come later. It is an insidious condition. Good luck.

[George2467814]

I'm 84 diagnosed 3years ago with slow irregular. Heatbeat I knew nothing of AF but GP said I should consider if I wanted to take Warfarin...I replied you know my condition and other issues I have would he take Warfarin if he were me....he said he would so I have been on it every since then with no ill effects .it is only since joining AF site and reading so much that I realised the right decision was made for which I am most grateful....I take 3mg Warfarin and 2 1/2 mg Bisoprolol Dailey steady INR around 2.5....2.7

[8joanie]

So pleased to read a post from another 'oldie' like me.  I have been on Warfarin for many years, plus a lot of other medications and am very grateful to whoever it was that put me on it in the first place.