Post-stroke care tips to manage atrial fibrillation.

Atrial fibrillation (AF) is a common type of abnormal heart rhythm. In Singapore, 1.5 percent of the population aged 55 years and above have AF. The risk of AF increases with age from 0.1 percent in patients under 55 years old to 10 percent in patients who are 80 years old and above. AF increases the risk of stroke by 5 times.

What is Atrial Fibrillation (AF)?

The heart pumps blood throughout the body. In normal heart function, the four chambers of the heart beat in a coordinated way to ensure consistent blood flow. However during AF, one of the heart chambers beat irregularly and disrupts the rhythm, which affects blood flow.

How does AF increase the risk of stroke?

The irregular pumping of the heart can cause blood clots to form in the heart. Parts of the clots can dislodge and travel to block a blood vessel in the brain resulting in stroke.

What are the signs and symptoms?

Some people do not experience any symptoms and are unaware of their AF condition until discovered during a medical examination. 

Those who do have symptoms may experience the following: 

• Fast or irregular (skipped or extra) heartbeat
• Breathlessness
• Chest pain or fatigue
• Dizziness or lightheadedness

What are the Risk Factors for AF?

Common risk factors of Atrial Fibrillation are:

• High blood pressure
• Ischaemic heart disease
• Heart valve abnormalities
• Abnormalities of the heart’s pumping function
• Sick Sinus Syndrome (a type of heart rhythm disorder)

How is it diagnosed? 

Atrial Fibrillation is usually diagnosed with a recording of your heart’s electrical activity using an electrocardiogram (ECG) or prolonged heart rhythm monitoring (e.g. Holter).  

Do note that modern information technology (IT) gadgets which tracks heart rate and/or blood pressure, may not be able to pick up AF accurately. Therefore, do seek advice from your healthcare professional.

How is AF treated? 

The aim of treatment is to control the condition and prevent complications. Controlling AF may involve:

• Treating your heart rhythm to make it more regular
• Treating your heart rate to slow it down

Stroke Prevention

Besides treatment for AF, you may also be started on anticoagulants (blood-thinning medications), which help reduce the risk of getting a stroke. Your doctor will discuss with you regarding the use of anticoagulants.

Anticoagulants

Common anticoagulants that are used for stroke prevention relating to AF includes warfarin and the direct oral anticoagulants (DOACs) such as apixaban, edoxaban, rivaroxaban and dabigatran. 

What do I need to know about anticoagulants?

Medication

• Take your medicine daily and follow the dosing instructions.
• You should receive detailed counselling before taking anticoagulation medication.

Reduce risk of bleeding

There is a tendency that bleeding may be prolonged or you may bruise easily, when on anticoagulants. Therefore, avoid behaviors or activities that may increase the risk of injury or bleeding. 

Consult your healthcare professionals for advice

• Before taking vitamins, health products and/or traditional medicines— some of these may interfere with the effects of the anticoagulants.
• Before any dental or medical procedures— to verify if it is necessary to stop the anticoagulants to prevent any bleeding complications.

Seek medical attention

1. If you have uncontrolled bleeding, or
2. If you experience the following signs of bleeding:

• Persistent nausea, stomach upset, or vomiting blood or other material that looks like coffee grounds
• Excessive menstrual bleeding or bleeding between menstrual periods
• Dark red or brown urine
• Bloody or dark-coloured stool
• Multiple, unexplained bruises

How else can I prevent stroke?

There are other things that you can do to reduce the risk of getting a stroke, such as: 

Article available in Chinese, Malay and Tamil 

For more information on how to better manage your stroke recovery journey, visit Stroke E-Resources.

StrokeHub Video: 

Atrial Fibrillation (Extended Version) https://youtu.be/YLMqeLYR1Sw

Atrial Fibrillation https://youtu.be/LPMFZr_qh5Q