Patient information · Cardiovascular
Atrial fibrillation
the commonest preventable cause of severe stroke
Atrial fibrillation is an irregular, often fast heart rhythm. It affects around one in fifty adults and far more over 65, frequently causes no symptoms at all, and multiplies stroke risk about fivefold — strokes that are typically larger and more disabling than others. Treatment prevents most of them.
Call 999 if you have
- face droop, arm weakness or speech difficulty — act FAST
- chest pain lasting more than 15 minutes, or with sweating and nausea
- severe breathlessness at rest, or coughing frothy sputum
- fainting, or feeling you are about to lose consciousness
- a very fast pulse with dizziness and chest tightness
AF greatly increases stroke risk, and stroke symptoms need an ambulance immediately — clot-busting treatment is time-limited. In an emergency call 999; the nearest emergency department is the Royal London Hospital, Whitechapel Road, London E1 1FR, a major stroke centre.
Checking your own pulse
This takes thirty seconds and finds a condition that is silent in around a third of people who have it. Place two fingers on the inside of your wrist below the thumb. A normal pulse is regular — even spacing, like a metronome. In AF it is irregularly irregular: no pattern at all to the gaps, and often fast. If it feels chaotic, get an ECG.
Symptoms, if any
- palpitations — fluttering, thumping or racing in the chest
- breathlessness, particularly on exertion
- fatigue and reduced exercise tolerance
- dizziness, light-headedness, chest discomfort
- Around a third of people have no symptoms and are found incidentally
Aspirin is not the treatment for stroke prevention in AF
For decades aspirin was given to people with AF who could not or would not take warfarin. It is no longer recommended — it is substantially less effective than anticoagulation and carries a similar bleeding risk, so it offers the worst of both. Current treatment is a direct oral anticoagulant (apixaban, rivaroxaban, edoxaban or dabigatran), or warfarin in specific circumstances. If you have AF and are on aspirin alone for stroke prevention, that warrants a review.
Assessing your stroke risk
The score counts age, sex, high blood pressure, diabetes, heart failure, vascular disease and previous stroke. Anticoagulation is recommended for most men scoring 1 or more and women scoring 2 or more. Bleeding risk is assessed to identify modifiable factors — blood pressure, alcohol, medicines — not to withhold treatment.
Rate or rhythm
- Rate control — letting the rhythm stay irregular but slowing it, usually with a beta-blocker. Appropriate for many people, particularly if symptoms are mild.
- Rhythm control — restoring normal rhythm with medication, cardioversion or catheter ablation. Favoured for younger people, those with symptoms despite rate control, and where AF is recent.
- Anticoagulation continues regardless of which strategy is chosen, and usually even after successful ablation — because AF can recur silently.
What you can change
Reduces AF burden
- Losing excess weight — strong evidence, 10% loss meaningfully reduces episodes
- Treating sleep apnoea, which is present in many people with AF
- Reducing alcohol — one of the clearest triggers
- Controlling blood pressure and diabetes
- Regular moderate exercise
Common triggers
- Binge drinking — so-called holiday heart
- Caffeine in some people, though less than commonly assumed
- Dehydration and acute illness
- An overactive thyroid — always checked at diagnosis
- Stimulants and some decongestants
Driving
You do not need to tell the DVLA about AF for an ordinary car or motorcycle licence provided symptoms are controlled and you are not disabled by dizziness or fainting. If AF has caused you to faint or feel you might, you must stop driving and notify the DVLA. Bus, coach and lorry licences have stricter requirements. We can advise on your particular case.
Why come to us. AF is found by a thirty-second pulse check and a ten-minute ECG, and confirming it is what unlocks stroke prevention. We perform ECG and echocardiography on site with results the same visit, take thyroid function, kidney function and full blood count in-house, calculate your stroke and bleeding scores with you, and prescribe anticoagulation. Ambulatory monitoring and cardiology procedures are arranged through our CQC-registered partners. Seven days a week, no referral.
ECG and echo on site, results the same visit
Cardiology without a referral. Seven days a week, 9am–7pm.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.