At 58, is my dizziness related to atrial fibrillation?

Question

Hello, Doctor,

I am a 58-year-old woman experiencing episodes where my heart feels like it is racing or fluttering irregularly, especially when I am stressed or have had caffeine. My EKG confirmed atrial fibrillation, and my echocardiogram showed mild left atrial enlargement with an ejection fraction of 55%. My BNP levels are elevated at 180 pg/mL, and I have controlled hypertension with medication. Sometimes I feel dizzy or short of breath during these episodes, and they can last anywhere from a few minutes to several hours. Please tell me,

Could this atrial fibrillation lead to stroke or heart failure?
Do I need blood thinners to prevent clots from forming in my heart?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Yes, atrial fibrillation (AFib) can definitely lead to stroke because when the atria beat irregularly and do not contract properly, blood can pool and form clots. These clots can then travel to the brain and cause a stroke.

Your echocardiogram (EKG) shows mild left atrial enlargement, which may further increase that risk. B-type natriuretic peptide (BNP) is slightly elevated, which may indicate early cardiac strain. However, the ejection fraction (EF) remains preserved at 55 %, so this does not suggest heart failure at present. Uncontrolled AFib over time can increase the risk of developing heart failure. Blood thinners are generally recommended in situations like this unless there is a strong reason not to use them.

Probable reasons behind these can be,

AFib is likely triggered by stress, caffeine, and possibly age-related changes in the atria.
Mild left atrial enlargement provides a structural substrate for AFib.
Elevated BNP suggests some atrial and ventricular wall stress during AFib episodes.

I suggest you do the following investigations;

Calculation of the CHA₂DS₂-VASc score (Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke, Vascular Disease, Age, Sex Category) to determine the need for anticoagulation. A score of 2 or higher generally supports anticoagulation.
Holter monitoring to assess AFib burden and heart rate control.
Complete blood count (CBC) and kidney function tests before starting anticoagulant therapy.

Other possibilities resons behind this can be,

Paroxysmal atrial fibrillation (AFib), which is the most likely diagnosis.
Supraventricular tachycardia (SVT) is particularly problematic if the rhythm is sometimes regular.
Anxiety-related palpitations, although AFib has already been confirmed on an electrocardiogram (ECG).

I suggest the following treatment plan,

Stroke prevention through an oral anticoagulant. A direct oral anticoagulant (DOAC) is generally preferred to reduce the risk of clot formation.
Rate or rhythm control using a beta-blocker or calcium channel blocker to control heart rate during episodes.
If episodes are frequent and symptomatic, rhythm control strategies may be considered, including antiarrhythmic medications or electrical cardioversion.
Trigger management, including limiting caffeine intake, managing stress, and maintaining good sleep habits.
Blood pressure (BP) control, to keep BP below 130/80 mmHg, as hypertension increases the risk of AFib progression.

Preventive measures that are helpful for you are,

Avoid dehydration, excessive alcohol consumption, and high caffeine intake.
Exercise regularly, but avoid extreme exertion until AFib is well controlled.
Maintain a healthy body weight, as obesity is a significant risk factor for AFib progression.

I hope this information helps you.

Feel free to ask further queries.

Thank you.