Is heart flutter with fatigue in elderly a concern?

Question

Hello doctor,

I am reaching out to discuss my 68-year-old mother's ongoing cardiac symptoms, which have been a source of growing concern. Over the past several months, she has experienced episodes of irregular heart rhythms. She describes sensations akin to a "fluttering" or "flopping" in her chest, accompanied by significant fatigue during routine activities, such as climbing stairs. Recently, she experienced a particularly alarming episode where her heart rate accelerated dramatically while at the grocery store, leading to dizziness and near-fainting.

She has been prescribed blood thinners but struggles with adherence to the medication regimen. Additionally, she manages diabetes, which adds complexity to her overall health status. She lives alone, and I am deeply concerned about the possibility of her experiencing a severe episode without immediate assistance.

Her last electrocardiogram indicated irregular heart rhythms, yet she has postponed follow-up appointments. She also reports nocturnal shortness of breath and has been experiencing sleep disturbances.

Given these factors, I am particularly worried about her risk of stroke. Could you please advise on:

Is there an urgency to seek medical evaluation for her current symptoms?
What are the specific warning signs that would necessitate immediate emergency care?
What are the strategies to ensure she adheres to her prescribed medication regimen?

Your guidance on managing her condition and mitigating potential risks would be greatly appreciated.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I completely understand your concern.

Based on the symptoms you have described, it appears she is experiencing uncontrolled atrial fibrillation (AFib), a heart rhythm disorder affecting the upper chambers (atria) of the heart, which is contributing to her current health issues.

AFib can significantly increase the risk of stroke (a serious medical emergency that occurs when blood flow to a part of the brain is interrupted, either by a blockage or bleeding), particularly when blood-thinning medications are not taken consistently. It is crucial to manage this condition effectively to reduce such risks.

AFib often arises due to underlying factors such as high blood pressure, ischemic heart disease, structural heart abnormalities, or electrolyte imbalances. Identifying and addressing these root causes are essential steps in her treatment plan.

The comprehensive management of AFib typically includes:

Heart rate control: Medications like beta-blockers or calcium channel blockers can help regulate the heart rate.
Rhythm control: Anti-arrhythmic drugs may be used to restore normal heart rhythm. If medications are ineffective or if the patient is unstable, procedures like electrical cardioversion, where a controlled electric shock is administered, can be considered. This procedure is generally safe when proper precautions are taken.
Anticoagulation therapy: Consistent use of blood thinners is vital to prevent stroke.
Treatment of underlying causes: Addressing issues like hypertension or electrolyte imbalances (minerals like sodium, potassium, calcium, magnesium, chloride, bicarbonate, or phosphate are present at abnormally high or low levels in your body fluids) can prevent recurrence.
Advanced interventions: In cases where medications and cardioversion are insufficient, procedures such as catheter ablation performed by an electrophysiologist to target and neutralize the sources of abnormal electrical signals, or the surgical maze procedure, may be recommended.

Regular follow-up with her healthcare provider is essential to monitor her condition and adjust treatments as necessary. Given that she lives alone, ensuring she attends all appointments and adheres to her medication regimen is particularly important.

Additionally, uncontrolled AFib can lead to cardiomyopathy, a condition where the heart muscle weakens, impairing its ability to pump blood effectively. An echocardiogram (a non‑invasive ultrasound examination of your heart that uses sound waves to create real-time images of its structure and function) would be beneficial to assess her heart's function and guide further treatment decisions.

I hope this helps.

Kindly revert if there are any queries.

Thank you.