What does your heart sound like?

If your heart rate and rhythm are irregular, it is very important to get it checked out. You can check out your pulse at your wrist or on the side of your neck. Irregularity may signal Atrial Fibrillation (AF) which is the most common cause of stroke, particularly after the age of 65.

Atrial Fibrillation results in a five-fold increased risk of stroke with worse outcomes. Strokes are usually caused by clots in the blood vessels that lodge in and block important arteries in the brain. The irregular inefficient fluttering (fibrillation) of the heart muscles is not strong enough to keep the blood moving smoothly around the body. When blood is stationary or moving sluggishly, it is inclined to clot.

Often when we get our blood pressure checked at the chemist, by a nurse or a busy GP, they miss the abnormal heart rhythm because they are using an electronic Blood Pressure (BP) monitor. The only alert that the electronic machine may give is an error message. The old-fashioned BP check by your GP or the nurse involves hand pumping a sphygmomanometer and then listening to your pulse at the elbow. It allows them to hear the rate and rhythm of your heartbeat which makes abnormal heart rates and rhythms more noticeable.

For most people who develop AF, they will know something is wrong because they may become short of breath and notice that their heart is pounding. Initially, this may come and go. For others, it is silent, and they may not notice anything different.

Not all irregular heart rates are serious. Assessment of the irregularity is performed with an Electrocardiogram (ECG), and the underlying state of your heart needs to be checked with an Echocardiogram.

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If you have AF, medication will be started to slow the heart down and stabilise its rhythm. Also, an anticoagulant is used which is medication to thin your blood and reduce your risk of a blood clot. Aspirin is not very effective at preventing clots triggered by AF and is seldom used now, even for low-risk patients. Warfarin has been the standard drug for a long time, but there are now some new drugs that do not require regular blood tests to monitor levels.

Warfarin reduces the risk of stroke by 84% in women and 60% of men. The stroke reduction for women with the newer anticoagulants is even better!

Other treatments, particularly if the symptoms are distressing, include electro cardioversion. It is treatment aimed to shock the heart back into a normal rhythm followed by maintenance with rhythm control drugs. There are other techniques that are used when the symptoms of the AF are very distressing and limiting.

All of this seems pretty drastic for an irregular heart rate. As I have indicated at the beginning of this article, untreated AF is a major cause of stroke, especially with other associated health problems such as hypertension or diabetes. The result can be a very disabling stroke. Women are at a higher risk according to a Euro heart survey, showing that they have double the rate of blood clots than men with AF.

The older we become, the greater the risk of developing AF. Treating it means that we can live out our years independently and with passion. Having a stroke often leaves people severely physically challenged and requiring permanent care. Check out your heart with your GP and ensure that you don’t have AF. If you do have the condition, adhere to your treatment, even if you don’t have any symptoms, as the alternative may be a stroke with its attendant disability.


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