Get Rhythm—What Women Need to Know About Afib
Do you have rhythm?
According to the Centers for Disease Control and Prevention (CDC), an estimated 2.7 to 6.1 million people don’t. Instead, they have a condition known as “atrial fibrillation”—also called “Afib” or “AF”—that causes the heart to beat too fast, too slow, or in an irregular way. The condition increases the risk of heart disease and stroke, and more women are affected than men.
The death rate from Afib is rising, and has been rising for the last two decades. Because of the increasing danger, and because many people are unclear about exactly what Afib is, the Heart Rhythm Society (HRS) and other organizations worked with the U.S. Senate to designate September as National Atrial Fibrillation Awareness Month.
What are the symptoms of Afib? Would you know if you had it? What should you do if you are diagnosed? We answer these questions and more for women and their loved ones.
What is Afib?
If you’re not sure what Afib is, you’re not alone. According to a 2014 survey, nearly half of respondents didn’t know the primary symptoms of Afib, and most were unaware of other common symptoms. Almost 80 percent didn’t know that the condition could exist with no symptoms at all. Most were unaware of common risk factors like diabetes and sleep apnea, and 44 percent didn’t know that medications could help restore a regular heart rhythm.
So what is Afib? Basically, it’s an irregular heart rhythm. Instead of beating steadily like normal, the heart typically beats too quickly and in a spastic manner, so that it actually quivers. This makes the heart less efficient, and can increase the risk of blood clots.
In a regular healthy heart, the two top chambers, called the “atria,” squeeze first, and then the two bottom chambers, called the “ventricles,” squeeze next. This back and forth creates a pulsing, contracting movement that pumps blood through the arteries.
In someone who has Afib, the electrical signals that direct the heart’s movements are disorganized and tend to misfire. This causes the two upper chambers to “fibrillate,” or contract quickly and irregularly. Blood pools in the atria instead of going on into the ventricles like it should.
This “pooling” effect is what can increase the risk of blood clots.
What are the Symptoms of Afib?
Sometimes women with Afib don’t even know it. It can show up in brief episodes, after which the heart returns to a normal rhythm. Others have more ongoing fibrillation, which can cause the following symptoms:
- Rapid heartbeat
- Dizziness, sweating, and chest pain
- Heart palpitations
- Shortness of breath
- Quick tiring during exercise
Doctors generally classify Afib in four categories: 1) occasional, where symptoms come and go, 2) persistent, where treatments are needed to restore a regular heartbeat, 3) long-standing, where Afib lasts for a year or more, and 4) permanent, where the abnormal heart rhythm can’t be fixed, and ongoing treatments are necessary.
Women who are more at risk of developing Afib include those who have:
- heart disease
- an obese body weight
- risk factors for heart disease, like high blood pressure
- a heart defect from birth
- gone through heart surgery in the past
- lung disease
- sleep apnea
- overactive thyroid gland
- other infections
- family members with Afib
- use alcohol or drugs heavily
Without treatment, Afib can lead to other complications, including stroke, heart failure, chronic fatigue, and additional heart rhythm problems. People who have Afib have about a five times greater risk of stroke than people without it.
How is Afib Treated?
Women who experience any of the symptoms above should see their doctors. Diagnostic tests include an electrocardiogram (ECG) to check the electrical signals in the heart, an echocardiogram to create a video image of the heart, blood tests, and chest x-rays.
Treatment most often includes medications that help to restore a regular heart rhythm and prevent blood clots. For some patients, electrical cardioversion—an electrical shock to the heart—helps fix the problem, at least temporarily.
If neither medications nor electrical cardioversion work, doctors may recommend surgery. During these procedures, surgeons usually destroy the area of the heart that’s causing the erratic electrical signals, which restores normal rhythm. Some patients may also use pacemakers to keep the heart rate steady.
How Afib Differs in Men and Women
You’ve probably heard that the symptoms of a heart attack in women can be different than those in men. Whereas men may experience chest pain and heart palpitations, women may experience more fatigue, chest pressure, and vomiting.
Studies have shown similar differences in Afib symptoms. In a 2012 study, for example, women typically experienced more symptoms of Afib than men did, including palpitations, lightheadedness, and chest tightness and discomfort.
Women who have the disease also tend to have different accompanying health conditions. In 2013, researchers reported that women with Afib were more likely to also have thyroid dysfunction, depression, kidney impairment, and obesity. The men were more likely to have coronary artery disease and/or chronic obstructive pulmonary disease (COPD). The women were also more likely to live alone, and to have a higher risk of blood clots.
A later review of over 30 studies showed that women with Afib were more at risk for stroke and blood clots when not taking blood-thinning medications. Researchers also found that women suffered worse outcomes after an Afib-related stroke than men did, in terms of being able to return to their normal lives.
Why would women be more at risk for blood clots and stroke? Scientists aren’t sure yet, but they have believe these factors may be involved:
- women are often older when diagnosed with Afib, which could increase risk of blood clots and stroke
- women with Afib are more likely to have high blood pressure, valvular heart disease, and heart failure than men
- women are more likely to have thyroid dysfunction, which can increase risk of blood clots
- women with Afib are more likely to have suffered a previous stroke
Scientists also think that women may be vulnerable to other changes in the blood vessels that increase the risk of blood clots.
Women Less Likely to be Prescribed Helpful Blood-Thinning Medications
Blood-thinning medications can help keep the blood flowing and prevent blood clots and related issues like heart attacks and strokes. Yet some studies have found that women are less likely to be treated with blood-thinning drugs than men.
One study showed that women over the age of 75 with Afib were one-third less likely to be treated with blood-thinning medications than men were. A Canadian study also showed that older women were half as likely to receive prescription blood-thinners than men, and a 2015 study found similar results.
Scientists aren’t sure why this is happening, but they suspect it may be that women are believed to be at a higher risk of bleeding than men. Blood-thinning drugs make the blood less likely to clot, which is good for preventing heart attacks and strokes, but it can also increase risk of excessive bleeding events, which can be very dangerous.
Some research has shown that women taking blood-thinning drugs have a higher risk of major bleeding compared to men. Other studies have not found that connection, however, and researchers have indicated that more women would benefit from blood-thinning medications.
How You Can Live a Full Life with Afib
If you or someone you love is diagnosed with Afib, your doctor may advise the following precautions. Otherwise, as long as you following your doctor’s advice, you can expect to live a long, active life.
- Limit caffeine—it can make the heart race.
- Eat a healthy diet to help protect the blood vessels.
- Cut back on alcohol as it can stimulate an episode of fibrillation.
- Ask your doctor about safe exercise options, and stay active to protect your heart.
- Control your weight, as overweight increases risk of Afib episodes.
- Stop smoking—nicotine increases the risk of heart attacks and strokes.
- Practice a daily stress-relieving activity—stress can trigger Afib episodes.
- Get enough sleep, and if you have sleep apnea, make sure you’re treating it.
- Ask your doctor about certain over-the-counter medications that may stimulate Afib. Cough and cold medications may have stimulants that encourage rapid heartbeat.
“Atrial Fibrillation Fact Sheet,” CDC, https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_atrial_fibrillation.htm.
Mellanie True Hills, “Atrial Fibrillation (Afib) Month Raises Awareness about this Common, Yet Unknown Condition,” AtrialFibrillationblog, September 21, 2011, http://atrialfibrillationblog.com/atrial-fibrillation-afib-month-raises-awareness-about-this-common-yet-unknown-condition/.
“September is National Atrial Fibrillation Awareness Month: Americans Lack Awareness About Atrial Fibrillation and Stroke Risk,” iRhythm Technologies and the National Stroke Association, September 22, 2014, http://irhythmtech.com/company/press-releases/september-national-atrial-fibrillation-awareness-month-americans-lack.
“What is Atrial Fibrillation?” National Institutes of Health, https://www.nhlbi.nih.gov/health/health-topics/topics/af.
Jocasta Ball, et al., “Women Versus Men with Chronic Atrial Fibrillation: Insights from the Standard Versus Atrial Fibrillation specific managemenT studY (SAFETY),” PLoS One, May 29, 2013, http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0065795.
Emily Y. Cheng, et al., “Gender Differences of Thromboembolic Events in Atrial Fibrillation,” The American Journal of Cardiology, March 15, 2016; 117(6):1021-1027, http://www.sciencedirect.com/science/article/pii/S0002914915300850.
Kristen Stewart, “Atrial Fibrillation in Men vs. Women,” EverydayHealth, https://www.everydayhealth.com/hs/atrial-fibrillation-and-stroke/afib-men-women/.
Natasha A. Kassim, et al., “Abstract 18038: Gender Differences in Anticoagulation and Stroke Outcomes in Atrial Fibrillation,” Circulation, November 10, 2015; 132(Suppl 3): A18038, http://circ.ahajournals.org/content/132/Suppl_3/A18038.