The first course of treatment for most people diagnosed with atrial fibrillation is management through medication. Patients are usually prescribed a combination of three types of drugs to control the heart rate and/or rhythm and to manage the risk of blood clots and stroke. Medication cannot cure afib, and must be taken consistently over your lifetime to prevent afib episodes.
Anticoagulant Medication (Coumadin® and warfarin)
Anticoagulants are commonly called blood thinners and are used to keep the blood from forming clots and prevent strokes. “What I have resigned myself to is that being on a blood thinner is a necessary evil,” shares Patty Borkowski, an afib patient. Patients must be vigilant in taking their medication and monitoring the thinness of their blood (measured by the International Normalized Ratio or INR.) “If an afib patient takes Coumadin® and has a consistent INR as prescribed, they have a 72% less likelihood for having a stroke,” explains Patty. “And I can’t tell you how that number “72%” has been branded into my brain. I have found it fairly easy to stay in control.”
“Warfarin is a hard drug to live on,” shares Eliz Greene, director of the Embrace Your Heart Wellness Intitiative. “Anything we can do to make women feel empowered about having control over it would be excellent.”
Tips For Women On Blood Thinners
- Be consistent in what you eat and drink.
- Check the label on supplements. Many multivitamins contain vitamin K. Herbal remedies with ginseng, gingko biloba, ginger, garlic, St. John's Wort and green tea will impact your INR. Check with your pharmacist before taking a supplement or over-the-counter medication.
- Be in control.
- Be vigilant in keeping INR testing appointments. Inform your health care provider about any changes in your diet or medications, including herbal and over-the-counter.
- Pay attention to bruising and your menstrual cycle. Excessive bruising and overly intense menstrual flow may be signs your INR is too high.
Heart Rate Control Medication: This medication slows down the heart rate by blocking some of the electrical signals.
There are three types of Rate Control medications:
Beta Blockers slow the heart rate and relax the blood vessels.
Calcium Channel Blockers relax blood vessels and reduce heart workload.
Cardiac Glycosides improve cardiac output.
Beta blockers are considered the most benign medications and thus are often a starting point for treating afib. But beta blockers still come with some side effects that women can find troubling, including extreme fatigue and dizziness.
For those with intermittent or occasional afib episodes, your doctor could prescribe the “Pill-in-the-Pocket” approach. Rather than taking the medication every day, patients keep it on hand and take it when they have an episode.
Heart Rhythm Control Medication:
Also called "drug cardioversion,” treatment with rhythm control medication may be used if rate control medications are not managing your afib.
Heart rhythm control medications include:
Sodium Channel Blockers improve the heart's rhythm by slowing the heart's electrical conduction.
Potassium Channel Blockers relax the heart muscle and slow the electrical signals that cause afib.
These medications are not long term solutions to afib due to very serious side effects and the risks that make constant heart monitoring necessary.
According to the patient resource StopAfib.org:
Amiodarone, a potassium channel blocker, is considered superior to other heart rhythm control medications in attaining and maintaining normal sinus rhythm, but may be the medication of last resort due to its lung toxicity and potential for long-term adverse effects. One patient who took amiodarone mentioned it can make you turn blue like a "Smurf." Now that's an undesirable attribute for a medication!
Patients that were on rhythm control drugs said that those medications just left them feeling badly and persistently tired. For most, these medications worked at first, and in some cases controlled their afib for years, but eventually just stopped working.
If the medication isn’t working and you are in persistent atrial fibrillation, your doctor could use electro cardioversion to convert your abnormal rhythm into a normal sinus rhythm.
For electrical cardioversion, the doctor will use a defibrillator to give your heart a jolt of energy through paddles placed on the front and back of the chest. This electric shock should restore your normal heart rhythm, and may take several tries. This treatment is used more often as a stopgap measure—in emergencies when Afib just won’t stop—and often does not last.
If medication is not managing your atrial fibrillation, talk to your doctor about other options such as surgical or catheter ablation.
The Patient's Perspective is a series of recorded teleconferences and articles presented by the Embrace Your Heart Wellness Initiative and hosted by Eliz Greene. Each teleconference focuses on a specific challenge facing women with heart disease. For more information visit www.EmbraceYourHeart.com
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Eliz Greene is a heart attack survivor, author and nationally known speaker on a mission to encourage women to recognize heart disease as their most serious health threat and provide down-to-earth strategies for active and healthy lives. Learn more about Eliz and the Embrace Your Heart Wellness Initiative at www.EmbraceYourHeart.com