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Health decoding｜Atrial fibrillation increases the risk of stroke and death. Treatment goals: Reduce the risk of complications
Atrial fibrillation is often viewed by medicine as a “silent killer”. The reason for this is that the symptoms of this disease vary from person to person and range from heart palpitations, shortness of breath, fatigue to no obvious symptoms. Many patients do not discover the problem because they feel “no pain and no illness.” Refusal to follow targeted treatment increases the likelihood of complications. Some cardiologists noted that treatment options for atrial fibrillation include drug therapy (including blood-thinning medications) and cardiac ablation surgery. However, the treatment strategy cannot be determined by the number of symptoms alone, but must be evaluated based on various risk factors and medical factors. The goals are not only: It improves the quality of life and reduces the risk of stroke caused by atrial fibrillation, even heart failure and death.
The incidence and prevalence of atrial fibrillation is increasing worldwide. Incidence also increases with age, with the overall prevalence ranging between 0.49% and 5.4% in the Asia-Pacific region and between 4.6 and 8.2% in those aged 70 to 80 years and over. A 2017 census study in Hong Kong found that the prevalence rate among those over 15 years of age was 1.8% and that among those over 80 years of age it accounted for an estimated 5% of the population. Cardiologist Tam Lok-yin pointed out that he believes there are many hidden cases in society because atrial fibrillation does not necessarily have obvious symptoms. In some clinical cases, the condition was discovered during a physical examination, while others were shocked to discover it was “atrial fibrillation” after complications such as a stroke occurred.
Ms. Zhang (pseudonym), who is in her 40s, is a relatively young patient with atrial fibrillation. Because her symptoms were mild and did not affect her daily life, she initially did not seek treatment. Until one day while riding the roller coaster she became ill and luckily was treated in time. After this fight, she decided to undergo medical treatment and surgery upon returning to Hong Kong.
The comprehensive score calculates the risk of stroke
Dr. Tan believes that whether patients with atrial fibrillation are treated or not is not based on the symptoms, but whether the risk of atrial fibrillation can be reduced after treatment: “The most dangerous complication associated with atrial fibrillation is stroke. If the left atrium is affected.” If the atrium trembles and cannot pump blood normally, the atrium expands and degenerates. When blood flow decreases, blood clots can easily form in the left atrium. If these blood clots enter with the blood flow and block the blood vessels in the brain, it will cause an acute stroke. There is a possibility that it could result in permanent disability or death.”
With this in mind, cardiologists evaluate the CHA2DS2-VASc risk score based on the patient’s age, gender, chronic diseases, stroke history and other factors. The higher the score, the greater the risk of stroke. Dr. Tan said male patients with a score of 1 or higher and female patients with a score of 2 or higher should consider taking blood-thinning medications to reduce the risk of stroke.
New blood-thinning drug has low risk of bleeding
Dr. Tam pointed out that the blood-thinning drug “warfarin”, which was more commonly used in the past, is now used less often because it easily conflicts with other medications and foods and patients need to have regular blood tests to adjust the drug dosage. This makes it less comfortable to use. Practical.
More than ten years ago, a new generation of blood thinning medications was brought onto the market. Patients no longer need to quit smoking and there are fewer medication conflicts. Studies have even shown that the effectiveness is similar or even better compared to warfarin. The risk of bleeding is similar to that of warfarin. If or lower. The risk of intracerebral hemorrhage is consistently lower than with warfarin. Nowadays, some blood-thinning medications are also available with a “reverse injection,” which can stop the effect of blood-thinning medications in a short time in cases of severe bleeding, quickly stabilize the bleeding situation, and further improve medication safety.
Dr. Tan said if you experience heart palpitations on weekdays, suddenly become tired, are short of breath and have irregular pulse beats, it is recommended to undergo a 24-hour or longer electrocardiogram or wear a wearable device to repeatedly track your heart rate rhythm for one long time to increase the diagnosis. Accuracy. Cardiac ultrasound is also a safe and commonly used test to determine the structural function of the heart and the condition of the heart valves. At the same time, you should also pay attention to whether you have any chronic diseases such as diabetes, high blood pressure or thyroid disease and control them properly to avoid aggravation of the disease.
Dr. Tan reminded that there are different treatment options for atrial fibrillation, each with its own effectiveness and side effects. Patients should actively discuss with their doctor to select the most appropriate treatment option.
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