Atrial fibrillation (AF) is a common heart rhythm disorder that causes an irregular and often rapid heart rate. While AF is not immediately life-threatening for most people, it does require prompt medical attention to prevent complications like stroke. Knowing when to go to the emergency room versus seeing your regular doctor is important. This article will overview AF, its symptoms, when it becomes an emergency, and provide tips on managing AF episodes.
What is atrial fibrillation?
Atrial fibrillation is a heart condition where the upper chambers of the heart (the atria) beat irregularly and rapidly. This causes the heart to pump blood less efficiently. AF symptoms include:
- Heart palpitations
- Fatigue
- Shortness of breath
- Chest pain
- Dizziness
AF can be occasional and resolve on its own (paroxysmal AF) or it can become persistent and ongoing. Often, AF has no identifiable cause but risk factors include high blood pressure, coronary artery disease, valvular heart disease, obesity, sleep apnea, thyroid problems, diabetes, and excess alcohol use.
Why atrial fibrillation needs treatment
AF requires treatment because it can lead to complications, primarily stroke. During AF, the atria do not contract properly and blood can pool and form clots. If a clot breaks off and travels to the brain it causes a stroke. AF increases stroke risk around 5 times.
Other complications of untreated AF include heart failure and chronic fatigue. Ongoing rapid heart rates may cause the heart to weaken over time. Prompt treatment restores normal heart rhythms and prevents complications.
Options for treating atrial fibrillation
Treatments for AF aim to either control heart rate or rhythm. Options include:
- Medications to slow the heart rate like beta blockers, calcium channel blockers, and digoxin.
- Blood thinners like warfarin or newer anticoagulants to prevent blood clot formation.
- Cardioversion – an electrical shock to the heart to restore normal rhythm.
- Catheter ablation – a procedure to scar heart tissue causing the irregular signals.
- Pacemakers and other devices to regulate heart rhythms.
The best treatment approach depends on the type of AF, other medical conditions, and patient preferences. Many people need a combination of rate and rhythm control treatments.
When to go to the emergency room for atrial fibrillation
In general, you should go to the emergency room for atrial fibrillation if you experience:
- Sudden onset of AF symptoms, especially if persistent palpitations lasting more than 48 hours
- Fainting or near fainting
- Chest pain
- Shortness of breath
- AF along with other symptoms of stroke like numbness, weakness, vision changes, trouble speaking
Emergency care can provide medications or electrical cardioversion to stabilize your heart rhythm. They will also assess you for complications like stroke or heart failure and provide lifesaving care if needed.
Situations that require emergency AF care
More specifically, the following situations indicate a need for emergency care:
- First onset of AF – Someone who has never experienced AF before and has persistent symptoms needs prompt assessment in the ER to determine the cause and rule out a medical emergency.
- Uncontrolled fast heart rate – If medications are not able to slow your heart rate and bring your heart back into normal rhythm, emergent cardioversion may be needed.
- Very slow heart rate – Some medications can cause the heart rate to become dangerously slow during AF. A very slow heart rate requires emergency treatment.
- AF with chest pain – Chest pain with AF could signal a heart attack, which is a medical emergency.
- Signs of stroke – Immediate treatment is needed if AF occurs along with signs of stroke like weakness, numbness, vision issues, or trouble speaking.
- Fainting – Fainting or nearly fainting is a sign of dangerously low blood flow and requires ER care.
- Unstable vital signs – If AF is accompanied by symptoms like low blood pressure, difficulty breathing, confusion, chest pain, rapid pulse over 150 bpm, seek emergency care.
- AF during pregnancy – Pregnant women who experience AF need monitoring as it poses risks to mom and baby.
Essentially if AF is new onset, unresponsive to medications, causing low blood flow, or showing signs of complications, call an ambulance or go to your nearest ER immediately.
Seeking prompt medical care for atrial fibrillation
Even if your situation does not require emergency care, new onset or uncontrolled AF should be evaluated promptly within 24 hours by a doctor.
You should call your doctor right away or go to urgent care for:
- First episode of AF
- Prolonged palpitations or episodic AF lasting over 48 hours
- AF along with moderate chest pain, shortness of breath, weakness, or dizziness
- Inability to control symptoms with usual AF medications
Prompt outpatient care can help identify the cause of AF, initiate medications to control heart rate, and monitor you for serious complications. Do not ignore new onset AF symptoms.
What to expect in the emergency room
If you go to the ER for atrial fibrillation, you can expect:
- Immediate EKG and heart rhythm monitoring
- Blood tests to check for signs of heart damage, anemia, thyroid problems, electrolyte abnormalities
- Oxygen, IV fluids, and medications to stabilize your heart rate and rhythm
- possibly electrical cardioversion if medications do not work
- CT scan or MRI if a stroke is suspected
- Echocardiogram to check heart function
- Overnight admission for monitoring if needed
Treatment focuses on slowing a rapid heart rate, restoring normal rhythm, and ruling out complications like heart attack or stroke. If your AF episode resolves in the ER, you will likely be discharged with medications and follow up instructions. For persistent AF, or signs of complications, hospital admission may be warranted for additional treatment.
When to see your doctor regularly for atrial fibrillation
In addition to seeking emergency or prompt care for concerning AF symptoms, it is important to have regular follow-up with your doctor to monitor AF and prevent strokes.
You should see your regular doctor:
- Within 1-2 weeks after any AF hospitalization or ER visit
- Every 3-6 months to monitor medications if you have persistent AF
- After any episodes of uncontrolled AF, fainting, or other concerns
- To have periodic EKGs and bloodwork to monitor heart rhythm and anticoagulation levels if on blood thinners
Ongoing medical management is key to preventing AF progression, stroke, heart failure, and other complications. Don’t cancel appointments with your cardiologist even if you feel your condition is under control.
Tips for deciding where to seek care for atrial fibrillation
With many options for where to seek care, it can be confusing determining where to go during an AF episode. Use these tips:
- Call 911 for severe chest pain, fainting, suspected stroke, or sudden onset of symptoms
- Go to the ER for rapid heart rates unrelieved by medication, signs of low blood flow, or suspected complications
- See your doctor promptly or go to urgent care for first episodes of AF, sustained palpitations, or worsening symptoms
- Schedule regular visits with your cardiologist to monitor AF even when your symptoms are controlled
- Take medications as prescribed and notify your doctor of any side effects or dosage issues
- Track your symptoms and heart rate at home so you can report them accurately
- Don’t delay care out of fear of COVID-19; ERs are taking precautions to prevent infection
Managing atrial fibrillation episodes at home
Many people with AF can manage occasional episodes at home with the following tips:
- Rest and avoid strenuous activity during AF
- Hydrate by sipping water
- Try vagal maneuvers like coughing or deep breathing
- Gently massaging the carotid artery may slow the heart rate
- Take your prescribed rate control medications
- Monitor your heart rate and symptoms
- Call your doctor if home treatments fail or you experience concerning symptoms like chest pain
Avoid trying to drive yourself to urgent care or the ER during an AF episode. Have someone else drive you or call an ambulance for safer transport.
Always seek medical attention if you experience first time AF, uncontrolled symptoms, fainting, or other red flags even if you temporarily manage some episodes at home. Do not disregard the risks of untreated AF which can lead to stroke and other complications.
Conclusion
Atrial fibrillation requires prompt medical care due to the risk of complications like stroke. New onset or uncontrolled AF warrants evaluation in the emergency room or at minimum an urgent visit with your doctor. Routine follow up is also key to monitor AF and prevent serious complications. With appropriate treatment, many people can manage AF and maintain an active lifestyle but don’t delay seeking care when symptoms arise. Knowing where to seek help allows for timely treatment and better outcomes.