I am 67, male. How can I manage irregular heartbeat?

Question

Hi doctor,

I am a 67-year-old male, and over the past few months, I have been experiencing episodes of rapid, irregular heartbeat that sometimes last for several hours.

During these episodes, I often feel palpitations, shortness of breath, and occasional dizziness. My home blood pressure readings have been around 145/85 mmHg, and my resting heart rate during palpitations reaches 140 to150 bpm. I also feel easily fatigued and sometimes experience mild chest discomfort. An ECG in the clinic confirmed an irregular rhythm consistent with atrial fibrillation.

Blood tests showed normal thyroid function, electrolytes, and kidney function, but my BNP was slightly elevated at 120 pg/mL. I have a history of hypertension and currently take Amlodipine 5 mg daily.

I am concerned about my risk of stroke or heart failure due to AFib. Could I need anticoagulants, and how is the choice made between Warfarin and newer oral anticoagulants? Are there lifestyle changes or medications that can help control my heart rate and prevent recurrent episodes? How frequently should I monitor my heart rhythm and follow up with you?

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

It is completely reasonable to feel worried after being diagnosed with atrial fibrillation, especially when you are experiencing symptoms such as palpitations, shortness of breath, fatigue, and dizziness.

Atrial fibrillation can indeed increase the risk of stroke and, in some cases, contribute to heart failure if the heart rate remains uncontrolled. However, with proper management, these risks can be significantly reduced.

Since you are 67 and have hypertension, you already have a moderate stroke risk, which means anticoagulation would likely be recommended to prevent blood clots from forming in the heart. The choice between Warfarin and newer oral anticoagulants such as Apixaban, Rivaroxaban, Dabigatran, or Edoxaban depends on several factors, including your kidney function, cost, ease of monitoring, and any other medications you take.

Warfarin requires regular blood tests to monitor INR (international normalized ratio) levels and careful dietary consistency, while the newer agents usually do not need routine blood monitoring and are generally preferred if there are no contraindications.

To control your heart rate, medications such as beta-blockers or calcium channel blockers may be added or adjusted. In some cases, rhythm control strategies or cardioversion may be considered depending on your symptoms and heart function. Lifestyle changes such as reducing caffeine and alcohol intake, maintaining a healthy weight, managing blood pressure, and staying physically active can also make a real difference in reducing episodes.

It is important to have regular follow-up visits, especially in the first few months after diagnosis, so your doctor can monitor your heart rhythm, blood pressure, and response to treatment.

Many people live full and active lives with atrial fibrillation once it is properly managed, and working closely with your healthcare team can help you regain confidence and control over your heart health.

I hope this has helped you.

Please feel free to reach out to me again for further queries.

Thank you.