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Exercise is key to living with AFib
Atrial fibrillation shouldn’t stop you from pursuing a healthy, active lifestyle. In fact, atrial fibrillation patients can reap many benefits by pursuing an exercise program. Exercise can reduce the frequency and severity of AFib episodes in addition to lowering blood pressure and slowing your resting heart rate. Of course, none of this means you should launch yourself into running a marathon after years of sedentary living. You need to be careful as you design your exercise program. Before you exercise, know what type of AFib you have There are four types of AFib: persistent, paroxysmal, vagal, and adrenergic. Knowing which one you have effects how you should approach your exercise routine. 1. Persistent AFib patients are nearly always in AFib. Since it’s usually best to exercise when one is not suffering from an episode these patients will need to be especially careful to stick to gentle, low-impact programs. 2. Paroxysmal AFib patients have episodes that come and go. Within reason, they can pursue just about any program they like, if they don’t overdo it. 3. Vagal AFib is when your episodes occur mostly during or after a meal or resting after exercise. This type of atrial fibrillation is related to the vagus nerve. For some people with this type of AFib, exercise can actually help stop the episodes. 4. Adrenergic AFib is when your episodes occur mostly during the day and are normally triggered by exercise, exertion, or stimulants. In this type of AFib the adrenaline hormone is the trigger. For some people with this type of AFib, exercise can trigger an episode. three people doing a yoga pose How to choose the right exercise program for you It’s important to start by focusing on light-to-moderate programs like brisk walking, Tai Chi, or yoga. Make sure you don’t get above 50% to 70% of your maximum heart rate. Calculate this by subtracting your age from the number 220. If you’re 40 years old your maximum heart rate is 180 and you don’t want to get above 126 bpm. If you’re on beta blockers you might have to use the Borg RPE scale as an alternative, since beta blockers exist to keep your heart rate low. The Borg scale is a measure of “perceived exertion.” The CDC offers a lot of information about it, but here’s the bottom line: you should aim to keep your perceived exertion somewhere between 11 and 14 on a 1-20 scale while you work out. Avoid weight lifting because it can put a great deal of strain on your heart. Strength training is important, but resistance band training is safer and more effective for AFib patients. Tips for a more successful exercise experience Be vigilant about taking care of yourself during your exercise time. This means setting realistic goals, staying hydrated, and watching for signs you may be overdoing it such as dizziness. If you’ve been sedentary for a long time, start out slow. Pay attention to weather conditions: the last thing you want to do is overheat. Think about personal safety, too. If you’re on blood thinners, for example, a major exercising accident could be very dangerous. Wear protective gear and take precautions to ensure you can get help if you have an injury that makes you bleed. an older man running in a park Beware of overdoing your exercise Pushing too hard is the number one reason why exercise may become unsafe for someone with atrial fibrillation. Don’t rely on monitoring methods or Borg scales alone. If you can’t speak a full sentence without gasping for air, then you are overdoing it. Lightheadedness, excessive sweating, and chest pains are other danger signs. You might feel like you’re “accomplishing more” when you start to push harder, but remember: even if you don’t trigger an episode your body will hit a wall. If you start associating exercise with pain and discomfort you won’t want to do it, and the least effective exercise is the one you never get around to doing at all. Keep exercise fun so you’ll want to do it…and don’t let AFib stop you from getting out there and getting active.
Do you know how to handle fatigue with AFib?
Between the sleepiness, fatigue, low energy and general malaise atrial fibrillation can be a draining disorder. While some people won’t detect too much of a difference in their energy levels, many of those who live with AFib complain of frequent fatigue that can interrupt their daily routine. What’s to blame for your low energy? The frequency and severity of your AFib episodes, your daily activity and habits, and your treatments can all factor into how tired you feel. Understanding what’s at the heart of your AFib fatigue is the first step. Once you know, you can apply some smart strategies to boost your energy. Where does your fatigue come from? When your heart beats faster than normal for a long stretch of time, the muscle gets tired. That’s the short answer. However, understanding what exactly is happening with AFib can help you pinpoint the problem (and hopefully help you to treat it). A rapid heart rate is a primary issue: healthy atria contract between 60 and 80 times a minute, but when your atria are in fibrillation, the contractions are incomplete. Instead, these upper chambers quiver – up to 400 times each minute. Although your AV node tries to calm this overactivity, it can’t halt every extra electrical impulse. These erratic electrical signals funnel into the ventricles, causing the heart to beat much faster than normal, and that can feel like an exhausting workout. A rapid heartbeat is only one part of the equation; inefficient blood flow can be another source of fatigue. When the atrial chambers flutter instead of contract, they can’t pump blood as well, which means the oxygen-rich blood your tissues rely on won’t always reach them. When your tissues and organs run out of fuel, you can feel weak and tired. Is another condition at play? It’s not unusual for AFib to come with (or from) other chronic conditions, especially if that other issue has been mismanaged or gone untreated. Cardiovascular disease is a significant risk factor for AFib, and it can bring side effects like shortness of breath, and, in turn, decreased energy. Congenital heart defects can also be to blame – for some people, one of the first warning signs of a defect is shortness of breath and fatigue. Although older age, high blood pressure, and heart disease top the list of fatigue risk factors, other health issues can also drain your energy and encourage AFib symptoms. Sleep apnea, asthma, and COPD can all interfere with how oxygen moves to your tissues, which means they can cause even more fatigue than you’d have with AFib alone. Change your habits, change your energy levels Managing your AFib symptoms is a key to improving processes in your body and boosting your energy levels. You can modify your routine to respect your limitations, helping you to conserve more energy to use throughout the day. And by working to keep your symptoms to a minimum, you can avoid the consequences of a prolonged elevated heart rate. Move in intervals. When you parcel your activity into shorter stretches, your energy stores can last longer. Try to space out your errands through the course of your day. When you exercise, alternate a few minutes of effort with a few minutes of rest, to better balance your cardio benefits with AFib symptom management. You might find your energy levels are higher at a certain time of day. Pay attention to those patterns – it can help you plan your activities strategically. Mind your minerals. Many people – and AFib patients in particular – tend to have low levels of magnesium, which can manifest in a number of ways, like muscle twitches, cramps, and fatigue. Since magnesium is crucial for healthy cells, you’ll want to make sure your magnesium level is topped up. Look out for the warning signs of a magnesium deficiency: when your AFib symptoms come alongside discomforts like muscle spasms, insomnia, and irritability, you might need more magnesium. While a balanced diet can help bring up the level of this electrolyte, it probably won’t be enough. Supplements, in the form of pills or topical spray, can be an easier and more effective way to get magnesium to your tissues and relieve some of the extreme fatigue. Check in with your sleep A healthy lifestyle is vital, but focused AFib management plays an important role in your quality of life, too. Sleep is incredibly important for your body to reset and recover. Your sleep needs can change as your age or as your AFib progresses, so it’s a good idea to look closely at your routine to make sure you’ve done what you can to keep symptoms under control.
Explaining heart rhythm problems in young people
Heart problems are often tied to aging. Your risk of several types of cardiovascular events, including atrial fibrillation, climbs higher as you approach middle age. But while atrial fibrillation or AFib risk does go up as you age, this is one heart disorder that could hit at any point in life. Although the majority of AFib diagnoses happen over the age of 60, more and more young people – even teenagers and 20-somethings – are suffering from the heart condition. This trend could be partly traced to better diagnostic tools and more awareness, but whatever the reason, it’s important to know the facts and challenges surrounding an AFib diagnosis in young adults. 5 causes of AFib in young people Wear and tear on the heart adds up over the years, which can lead to coronary artery disease, high blood pressure, and heart attacks – some of the most common causes of AFib. However, there are often different reasons behind an early AFib diagnosis, like congenital defects, unhealthy habits, and other illness. It can be especially difficult to uncover the root cause of AFib in young people, but these are a few of the most commonly detected sources: 1. Stress. Stress is a major trigger of many conditions. Experts agree that it can have a direct and severe impact on AFib. Of course, stress comes in different packages at different stages of life, and for young people, the mix of school, social dynamics, and future planning can bring an overwhelming dose of stress. How does stress lead to AFib? The stress response can activate the heart, jumpstarting electrical signals and encouraging AFib symptoms in those prone to them. Both mental and physical stress can cause this response, and in either case, you may need behavioural treatment as well as medication to resolve the issue. 2. Mineral imbalance. A fine balance of minerals, vitamins, water, and calories helps your body to function well. Unfortunately, it’s relatively easy to let your magnesium, calcium, potassium, and hydration levels lag – and that can set the stage for AFib. It’s unfair to label young people as poor eaters – many consume a wholesome, balanced diet that serves their physical and mental health. However, many other young people subscribe to a processed food diet, which is usually deficient in many important nutrients. 3. Infection. Pericarditis, an infection that can develop around the heart membrane, could lead to AFib, but so could other bacterial infections that aren’t directly affecting the heart. Research has found that the level of C-reactive protein, an important marker of inflammation, is measurably higher in people with AFib. Dental infection or disease could also cause trouble. You may have heard that gum disease increases your risk of some cardiovascular disease, but a recent study turned up a link between periodontal health and AFib, too. Experts suggest regular scaling to keep the inflammation down and mitigate your risk of heart rhythm problems. 4. Drug abuse. Illicit and commonly-prescribed drugs can trigger AFib, whether or not you have a pre-existing heart disorder. Stimulants are more often to blame, like nicotine, alcohol, and caffeine. Doctors have also discovered that opioid use can lead to heart rhythm irregularities, and given that more teenagers and young adults are misusing prescribed opioids, this poses a grave danger. 5. Comorbidities. Congenital defects could cause AFib to manifest earlier in life, as can other metabolic disorders, like diabetes. Hypertension, hyperthyroidism, and pulmonary embolism could also be at the root of the problem. For young people who suspect or know they have AFib, it’s important to work closely with your doctor to conduct a thorough examination of your medical history and physical health, in order to uncover any other illnesses that could be complicating matters. Understanding Lone AFib When atrial fibrillation develops before the age of 60 and without any related conditions, it’s known as lone AFib. In some cases, lone AFib is associated with a thyroid disorder, viral infections, or stimulant use, or it can be traced to family history. However, in many other cases, there’s simply no clear explanation for early-onset lone AFib. Your doctor might first want to rule out factors like extreme exercise and sleep apnea – sometimes these are missed in the initial investigation. But even as diagnostic technology advances, little is known about why lone AFib happens. Fortunately for some, a course of medication can eliminate the AFib symptoms; for others, symptoms could come back, sometimes permanently. Anyone under 60 who experiences AFib symptoms like palpitations, shortness of breath, or dizziness needs to visit a doctor. It can be tempting to ignore the discomfort, especially if it’s mild and you don’t have any other health problems, but the sooner you can start treatment for AFib, the better your chances of preventing it from getting worse.
Similarities, differences, and links between AFib and anxiety attacks
So many common symptoms of atrial fibrillation resemble classic anxiety symptoms that characterize panic attacks: heart palpitations, chest pain, muscle tension, and sweaty palms that come with an adrenaline rush are good examples. Luckily, these symptoms are generally short-lived, whether it’s an AFib episode or a panic attack. However, in order to treat your body properly and sidestep potential complications down the road, it’s important to distinguish the two conditions. Looking out for the telltale signs AFib is notoriously tricky to diagnose on your own, but there are some signs that can help you tell panic attacks and AFib episodes apart. It’s important to keep in mind that the two syndromes stem from different sources: AFib is an electrical disorder that sends a mess of signals through the chambers of the heart, but a panic attack typically won’t have a physical cause. Rather, it’s triggered by events in your environment, stressful situations, or sometimes happens for no apparent reason at all. Here are a few markers that can help you tell the conditions apart: Rate of decline. Pay attention to the rate of building and declining symptoms. Since AFib is triggered by a sudden physical event (overactive electrical signals), AFib episodes typically hit suddenly. When the episode subsides, so will the symptoms, but the cycle tends to repeat until treatment is administered. With a panic attack, heart rate can start to creep up as other discomforts manifest, and after the attack hits a peak, heart rate will gradually return to normal as the other symptoms dissipate. Nature of the heartbeat. The pattern or rhythm of a heart beat can also tell you what’s going on: a panic attack typically brings a constant rapid heart rate, while AFib causes an erratic heart rate. If your heart seems to be skipping beats, or speeding up then slowing down and speeding up again, it’s more likely that AFib is to blame. Related emotions. Panic attacks often bring what people describe as a sense of doom: a heavy and urgent feeling like something very bad is about to happen. This fear and helplessness is tough to shake and can feed the panic that brought it on. While an erratic heartbeat isn’t pleasant, AFib doesn’t usually bring such a severe emotional response. Type of pain. AFib and panic disorders can both bring on chest pain as the heart races and muscles tense. A dull chest pain is not uncommon, but everyone experiences pain differently. When AFib hits alongside another heart disorder, the pain can be more specific and intense – and it’s never a good idea to ignore. If you get any chest pain during an attack or episode, see your doctor to investigate further. Anxiety is a very personal experience, and can be troubling, but take comfort in the fact that it will subside. Unfortunately, AFib may not go away without some help, so you’ll want to make sure you know what you’re dealing with as soon as possible. Relieve anxiety, reduce AFib Anxiety and AFib play off each other, and that’s no good for your body or your mind. If you know that anxiety triggers your AFib, make it a priority to get the stressors in your life under control as you craft a more heart-healthy routine. If anxiety is too much to bear, don’t suffer alone – talk to your doctor about adding anxiety medication to your health management. You may not need to take it every day, only when things get very bad, but knowing that you have something on hand for emergencies can go far to reassuring yourself that you’ll get through the panic should it strike again. Next, add exercise. Workouts don’t need to be strenuous, but they do need to be regular: you’ll see more positive physical and psychological results when you commit to exercising several times a week. If you’re not sure where to start, you may first want to meet with your doctor and a trainer to measure your current level of fitness, so you can choose an appropriate workout that respects your limits. Turning a negative into a positive A panic attack or an AFib episode can bring a rush of frightening energy, as adrenaline courses through your body and your mind jumps to worst case scenarios. You could try to wait it out and distract yourself with an activity, but sometimes it’s impossible to calm your anxious response by sheer will. Instead, you might try to turn the rush of fear into a rush of excitement: force yourself to think of an exciting event or possibility, or simply start dancing and laughing. It sounds counterintuitive, but you may be able to flip the nature of your feeling from bad to good, and although this probably won’t make your symptoms go away, they will become easier to handle. Relaxation, support, confidence, and commitment – these are the ingredients of a smart and effective management plan for AFib and for anxiety. If either set of symptoms begins to take over your thoughts and lifestyle, it may be time to seek a new perspective or professional guidance. The good news is that there are plenty of techniques that can interfere with the AFib-anxiety cycle, and help you regain some control.
Understanding the connection between heart health and brain function
When you live with atrial fibrillation, you may take medication to prevent blood clots and control uncomfortable symptoms. While this can improve your quality of life in the short term, the long-term outlook may be less rosy. That’s because new research shows that AFib symptoms and common treatments could damage the brain, leading to a decline in memory and language skills. A network of nerves and blood vessels connect these two organs, but the heart and brain can influence each other through a variety of pathways. Some studies have shown an association between AFib and Alzheimer’s disease, which means there could be processes at play that you might not have considered. The mental decline known as dementia is a frightening reality, but it’s certainly not set in stone. You can help or hinder your body with your lifestyle and treatment choices, but first you’ll need to understand some of the challenges you could face when you live with AFib. Stroke risk is a factor Blood clots leading to stroke are major concerns for anyone living with AFib – they’re also a direct link between heart and brain function. An irregular heartbeat left untreated can cause blood to pool in the heart and clots may form in the pooled blood. If a clot travels to the brain and lodges in a blood vessel, you could experience the classic physical signs of stroke, like blurry vision, slurred speech, and weakness on one side of the body. Strokes can manifest in different ways. Some strokes come with sudden and pronounced symptoms, while others are silent. These small and quiet strokes can go undetected, affecting cognition in more subtle ways. Over time, that damage can add up, and cognitive changes can become more obvious. Your risk increases with age Aging is a challenge for a lot of people at the best of times; the older we get, the tougher certain actions, reactions, and natural processes become. Your AFib risk and your dementia risk rises as you age, especially as you approach 80. One study published in the journal Neurology found that AFib can bring on Alzheimer’s at an earlier age than in people without AFib. This report didn’t tie cognitive decline to stroke – rather, patients with AFib who had never had a reported stroke still experienced earlier cognitive decline than average. The effect of AFib treatment on dementia risk It seems that there’s some link between AFib and dementia (though studies continue to determine just how strong that link is). There also appears to be a connection between certain AFib medications and the risk of mental decline. Blood thinners could actually protect the brain The good news about the heart-brain link is that certain blood thinning medication could actually help to stall the onset of dementia. Results of a recent study published in European Heart Journal show that AFib patients on a blood thinning medication at the beginning of the study were 29 per cent less likely to develop dementia than the other participants. Where does the benefit come from? One theory is that anticoagulants like Warfarin not only protect against major strokes, but also against mild or mini-strokes, the often invisible events that could add up to significant long-term cognitive decline. Where does the benefit come from? One theory is that anticoagulants like Warfarin not only protect against major strokes, but also against mild or mini-strokes, the often invisible events that could add up to significant long-term cognitive decline. However, there’s a fine balance when it comes to blood thinners and brain health: while blood thinning medication is designed to prevent clots, too much of it can cause microbleeds in the brain. The lesson here is that close monitoring could make all the difference. Speak with your doctor regularly about tracking the amount of medication in your body and revisiting your treatment plan periodically to make sure dosage is still sufficient. Lifestyle changes for mental longevity Losing weight and improving your general cardiovascular fitness could have a measurable impact on cognitive complications. One 2016 study found that, of the 355 AFib patients who participated in weight loss interventions, those who sustained their weight loss didn’t feel the burden of their AFib to the same degree as others – In fact, they were more likely to remain in a normal sinus rhythm. Since the effects of AFib can feed cognitive problems, it follows that the fewer AFib symptoms and episodes you have, the better it will be for your mental health. That’s a good reason to incorporate regular exercise into your AFib management plan. Looking ahead and staying positive More studies are needed to unveil more details of the AFib-dementia relationship, but recent findings show promise. There’s a bigger push to figure out how to use this relationship to our benefit, and for now, a good amount of evidence to suggest you should consider blood thinners as a main course of defense. In addition to thinning your blood, focus on other ways to manage heart dangers like high blood pressure. Since early intervention is so often the key to avoiding the worst case scenario, it’s crucial that you communicate well with your doctor. As new studies are scheduled and research advances, your medical team may be able to tailor a treatment plan to protects your brain as well as your heart. 5 tips to keep your A-fib in check
When you’re diagnosed with atrial fibrillation, you might think that life as you know it is over. Now you will have to watch for triggers, be prepared to handle sudden symptoms, and generally keep a lower profile than other heart-healthy people. In reality, there’s plenty that you can do to keep living the life you want – or make it an even happier, healthier, and more rewarding existence despite having Afib. It’s true that heart palpitations, chest discomfort, and anxiety are not fun to live with. But although it can be difficult to completely eradicate AFib symptoms, you can diminish their severity and frequency by making some clear and straightforward lifestyle changes. If you want to take your health seriously, consider these approaches to a stronger cardiovascular system. Tip #1: Make exercise a part of your life You’ve heard it before, but it can’t be said often enough: if you want to improve your energy, strengthen your heart, and increase your longevity, you need to make exercise a part of your everyday routine. Of course, living with AFib means minding your limits, so you’ll need to moderate your workout routine with the help of sound medical advice from your doctor and a keen focus on your body’s signals. Strenuous exercise can make an irregular heartbeat worse, but moderate exercise can bring long-term benefits, like weight loss and lower blood pressure – and that can help you ward off heart failure, which is a major risk for AFib patients. Consider a routine that balances regular, moderate aerobic exercise with stretching and strengthening activities like yoga. Tip #2: Minimize stress as much as possible Not only is stress a common trigger for AFib, it appears to affect the severity of symptoms, too. Psychological stress, which can manifest in forms like anxiety and depression, has prompted patients to visit their doctor more often with AFib complaints. Likewise, if you’re prone to anxiety or high-stress states, even moderate AFib symptoms could feed the cycle. Stress is personal and unique – your stress relief program should be as well. The first step is to be more observant: learn what brings on stress, where it tends to happen, and why you have such a difficult time controlling it. Then, explore your options. From innovative workouts to face-to-face therapy sessions, there are plenty of stress-relieving resources at your fingertips (and no reason to wait any longer to try them). Tip #3: Reduce your salt intake High-sodium lifestyles are the norm in North America, and they’re slowly chipping away at our health. It’s true you need salt to live, but when you take in too much – more than 1500 mg a day – your body’s mineral balance is thrown off, your blood pressure can go up, and your heart rhythm can suffer. Not a good combination for anyone, especially people with AFib. One simple first step is to decrease the amount of sodium you eat, which means drastically reducing frozen, processed, or takeaway meals. Pay close attention to labels (some foods have a surprising amount of sodium) and get used to cooking with flavorful herbs and spices rather than salt. You may also want to pay more attention to your minerals: electrolyte imbalances can feed AFib, so it might be time to up your magnesium and potassium to counter the sodium you take in. Tip #4: Watch out for stimulants like caffeine and alcohol Stimulants can feel great when you’re consuming them, but your heart often bears the health burden. If you’re prone to heart rhythm irregularities, you’re probably even more vulnerable to an adverse reaction to stimulants like caffeine, alcohol, and other drugs. Remember that stimulants can hide in products that seem harmless. Coffee and cola are prime caffeine sources, but caffeine can also be found in pain relievers and chocolate treats. Energy drinks are some of the worst offenders: they’re loaded with stimulating compounds, so even if they’re labeled “caffeine-free” you should avoid them altogether. Alcohol is one of the most common stimulants, and it has a direct impact on heart health. Even a couple of drinks can raise blood pressure and increase the risk of palpitations, so moderation is key. Wondering what moderation looks like for AFib sufferers? It can come down to personal physiology, so listen to your body and talk with your doctor about it. Tip #5: Try your best to avoid infections like the flu and more Getting sick is never comfortable, but it can be dangerous when you live with AFib. The flu is particularly threatening: symptoms like high fever can lead to dehydration, and respiratory problems causing hypoxia can stress your cardiovascular system. Your best defenses against the flu are frequent hand washing and the annual flu shot. Worried that this year’s vaccine won’t offer much protection? It’s still worth getting, because even if you were to contract the flu, the symptoms could be much more manageable – and that can make a big difference when those symptoms are known to interfere with your heart disorder. Implement these tips by establishing a routine How long does it take to form a habit? A lot depends on how difficult it is to adopt, and how quickly you can weave it into your daily routine. Some research suggests that it takes a little over two months for a new behavior to become automatic, which means you’ll have to stay focused on your lifestyle changes for a while, especially when it comes to tips like exercise and eating well. It’s easy to slide into old patterns, especially when life gets hectic. You may fare better with some support, like working out with a group or joining conversations in online forums to share challenges and tips on keeping (or kicking) a specific habit. The idea is to make it as easy as possible on yourself to adopt positive, lasting changes for the good of your heart. In this video we demonstrate the insertion of an IV into the external jugular vein.
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AuthorCarlo Oller, MD FACEP Archives
May 2019
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