What can we do for my mother at 63 with atrial fibrillation?

Question

Hello doctor,

My 63-year-old mom was diagnosed with atrial fibrillation (AFib) about three months ago, and we are very worried about her stroke risk and how her symptoms are affecting her daily life.

She first went to the ER (emergency room) with a racing heartbeat and chest pressure. Her ECG (electrocardiogram) showed an irregular rhythm with a heart rate of around 145 bpm (beats per minute). The cardiologist started her on Apixaban 5 mg twice daily and Metoprolol, but she is struggling with the side effects. The beta blocker makes her extremely tired; she sleeps most of the day, and her blood pressure sometimes drops to 90/55, causing dizziness. She even fell last week and bruised her hip badly, which is scary since she is on blood thinners.

Her echocardiogram showed left atrial enlargement and an ejection fraction of 48 percent. The doctor mentioned doing a cardioversion to reset her heart rhythm, but she is frightened about the procedure.

Another concern is bleeding. She suddenly started having heavy menstrual-like bleeding, even though she is 63 and had stopped having periods for two years. We are worried whether Apixaban is causing this or if there could be another underlying problem.

We also want to know if an ablation procedure might be a safer long-term option so she does not have to stay on these medications forever.

Could you please guide us on what might be happening?
What options should we consider?

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Atrial fibrillation, or AFib, can feel really frightening, especially when your mom experiences palpitations, fatigue, or dizziness. In AFib, the upper chambers of the heart beat irregularly and often faster than normal. This can make her feel her heart racing or fluttering unexpectedly.

Because the heart is not pumping efficiently, blood can pool in the upper chambers, which can form clots. That is why blood thinners like Apixaban are prescribed to reduce the risk of stroke.

If your mom still feels tired, dizzy, or notices palpitations even while taking a beta-blocker. It could mean her heart rate is not fully controlled. And factors such as dehydration, stress, poor sleep, caffeine, or alcohol can make the heart work harder. Managing these triggers can help her feel steadier and more comfortable.

AFib often occurs alongside other heart issues, such as high blood pressure, heart muscle problems, and electrolyte imbalances.

Treating these underlying conditions is key to controlling AFib effectively.

The main goals for managing AFib are to control the heart rate to keep it within a safe range, prevent blood clots using anticoagulants, treat underlying causes, and restore normal rhythm, if possible.

Treatment options include medications (first line), cardioversion (a small, safe electrical shock under sedation to reset the heart rhythm), catheter ablation, or maze surgery (procedures that target areas causing AFib). Even after procedures, your mom may still need beta-blockers or blood thinners.

Her ejection fraction is 48 percent, which is slightly below normal. This may happen due to rapid heart rhythms over time or other heart conditions. Her cardiologist will check for the exact cause and recommend appropriate treatment.

Vaginal bleeding at age 63 is not typical. Blood thinners can sometimes increase bleeding, but any new or heavy bleeding should be evaluated urgently. This could indicate other underlying issues that need attention.

I hope this answers your query.

Please let me know if I can assist you further.

Thank you.