Guidelines Cite Stringent Targets
The American College of Cardiology/American Heart Association Task Force/European Society of Cardiology guidelines make no definite recommendations about heart rate targets. The guidelines do indicate, however, that rate control criteria vary based on age, but usually involve achieving ventricular rates between 60 and 80 at rest and between 90 and 115 during moderate exercise.4
This guidance is based on data from epidemiologic studies suggesting that faster heart rates in sinus rhythm may increase mortality from cardiovascular causes.5 However, strict control often requires higher doses of rate-controlling medications, which can lead to adverse events such as symptomatic bradycardia, dizziness, and syncope, as well as pacemaker implantation.
When Should I See My Healthcare Provider
Theres no single schedule to follow. It all depends on your symptoms and treatment plan, and whether you need follow-ups after a procedure. So, its important to talk with your provider and make a plan together. Make sure you go to all your scheduled appointments. Keep track of the medications youre taking, and bring a list of your medications to every appointment. Its also a good idea to keep the list in your wallet so its with you in emergencies.
What should I discuss with my healthcare provider?
At each visit, be sure to share any new symptoms or problems youre having, such as side effects from medication.
Your provider will ask you questions, but its important to ask your own questions, too. For example, ask for advice on how to reduce your risk factors. Starting a new diet or exercise plan can feel overwhelming. Your provider will offer advice and also connect you with others who can help, such as dietitians. You may also want to ask about available health and fitness programs, including those that support your mind-body connection.
Finally, be sure to ask your provider before taking over-the-counter medicines, such as those for cold and flu, and nutritional supplements. Sometimes these products can affect your heart rate or interact with your prescription medications.
A note from Cleveland Clinic
What Happens In Atrial Fibrillation
When the heart beats normally, its muscular walls contract to force blood out and around the body. They then relax, so the heart can fill with blood again. This process is repeated every time the heart beats.
Atrial fibrillation occurs when abnormal electrical impulses suddenly start firing in the atria .
These impulses override the heart’s natural pacemaker, which can no longer control the rhythm of the heart. The atria contract randomly and sometimes so fast that the heart muscle cannot relax properly between contractions. This reduces the heart’s efficiency and performance and causes a highly irregular pulse rate.
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What Are The Types Of Bradyarrhythmias
A bradyarrhythmia is a slow heart rhythm that is usually caused by disease in the hearts conduction system. Types of bradyarrhythmias include:
- Sinus node dysfunction: Slow heart rhythms due to an abnormal SA node.
- Heart block: A delay or complete block of the electrical impulse as it travels from the sinus node to the ventricles. The level of the block or delay may occur in the AV node or HIS-Purkinje system. The heartbeat may be irregular and slow.
Importance Of Lifestyle Changes And Tracking Your Pulse
Long-term, what works the best to prevent or manage afib is lifestyle optimization, says Day. This includes maintaining a normal body weight, eating a healthy diet, getting good sleep, and regular physical activity.
Lifestyle changes can take care of about 50 percent of afib cases, says Day. For those who dont respond to lifestyle changes alone, the next best long-term option is to get afib ablation in conjunction with lifestyle optimization.
Day notes that tracking your pulse is easy and can be done in as little as 10 seconds a day. You can use devices like the Apple Watch 4, which has an FDA-approved electrocardiogram monitor built in to help detect afib. If you dont want to buy a watch or other wearable device, you can also take your own pulse without any special equipment. The main point is to be sure that your pulse is not too fast or too slow. And that its not too irregular.
A normal heart rate for most people will be about 50 to 90 beats a minute, and it should be regular, says Day. If you have a chaotic pulse, theres a good chance that you may be in afib.
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How Do I Take My Pulse
You can tell how fast your heart is beating by feeling your pulse. You can feel your pulse on your wrist or neck. Place the tips of your index and middle fingers on the inner wrist of your other arm, just below the base of your thumb. Or, place the tips of your index and middle fingers on your lower neck, on either side of your windpipe. Press lightly with your fingers until you feel the blood pulsing beneath your fingers. You may need to move your fingers around slightly up or down until you feel the pulsing.
You can count the number of beats in 10 seconds and multiply by six to determine your heart rate in beats per minute. A normal heart rate, at rest, is 50 to 100 beats per minute.
A note from Cleveland Clinic
There are many ways for your heartbeat to be irregular. Some of these irregular heartbeats, called arrhythmias, dont cause symptoms. Its important that you see your healthcare provider if you do notice symptoms like extreme fatigue or heart palpitations. Your provider will help you decide on the best treatment option for you, but you can help yourself by making appropriate lifestyle changes.
Last reviewed by a Cleveland Clinic medical professional on 03/22/2022.
References
Surprising Triggers For Afib
Atrial fibrillation, or afib, is a condition that affects your heartbeat and can lead to an increased risk of stroke. The good news is that you can help prevent it. Learn some of the lesser-known triggers.
From its triggers to its symptoms, atrial fibrillation can be unpredictable. Just as you can have atrial fibrillation without visible symptoms, you can experience an attack of atrial fibrillation without a trigger, says Smit Vasaiwala, MD, an assistant professor of cardiology at the Loyola University Health System in Maywood, Illinois. But most people are able to identify at least some of their afib triggers, and this knowledge can help decrease the frequency of attacks and lower your risk for stroke.
Youre probably aware of common afib triggers, including alcohol, smoking, exercise, and over-the-counter cough and cold medications. But have you considered these five lesser-known triggers that can be just as harmful to your heart?
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Understanding Afib: Slowing Down The Dancing Heart
In atrial fibrillation , half of the hearts four chambers arent beating properly, but are dancing around randomly without rhythm.
This sounds scary and, in some ways, its astonishing that people with AFib can function well at all. But remember that the heart’s upper chambers ” rel=”nofollow”> atria), which are malfunctioning in AFib, dont pump blood to the body or through the lungs. They simply pass blood on to the muscular lower chambers of the heart that do the hard work.
People with AFib tend to do fine when theyre not exerting themselves. Without treatment for AFibs fast heart rate, however, the ability to be physically active is greatly reduced and the heart muscle can be damaged over time. As with all of us, AFib patients benefit from consistent, moderate exercise. Thus, slowing down the heart in AFib is a key goal.
Sometimes finding the right solution for AFib patients is like a puzzle.
When George H., our 71-year-old patient with AFib, was first diagnosed, his heart rate was 150 beats per minute . With his heart rate this high, he felt that he could not do anything requiring even mild exertion.
During his first visit to the ER, he was given metoprolol, a beta blocker drug, to slow down his heart. When this dose did not consistently lower his heart rate below 100 beats per minute, his doctor doubled his dose.
What Are The Treatments For Atrial Fibrillation
The main goals of Afib treatment include:
- Controlling your heart rate.
- Regaining a normal heart rhythm.
- Reducing your risk of having a stroke.
Based on your symptoms, your healthcare provider will likely first prescribe medications to see if they help.
Medications
Medications to treat Afib may include:
- Rate control medications to prevent the ventricles from beating too fast. Examples include digoxin, metoprolol, verapamil or diltiazem.
- Rhythm control medications to help your heart beat in a normal sinus rhythm. Examples include procainamide, disopyramide, flecainide acetate, propafenone, sotalol, dofetilide or amiodarone.
- Blood thinners to reduce the risk of blood clots and stroke. Examples include warfarin, warfarin alternatives or aspirin.
Any medications can cause side effects. Rate control and rhythm control medications may make your arrhythmia worse or impact your lungs, liver or other organs. Blood thinners can cause bleeding, indigestion or a heart attack. Usually, the benefits of taking these medications outweigh your risk of side effects. Its important to discuss all risks and side effects with your provider.
Procedures and surgeries
If medications dont help your Afib, you may need a procedure or surgery.
Many procedures can be non-invasive, and newer treatment methods and technologies are constantly developing. Talk with your provider about the options that are best for you.
Can Afib go away?
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Cardiovascular And Circulatory Systems
When your hearts electrical system is out of whack, the chambers lose their rhythm. A common symptom of AFib is the sensation that your heart is flopping around inside your chest, or simply beating irregularly, causing palpitations. You may become very aware of your own heartbeat.
Over time, AFib can cause the heart to weaken and malfunction. The hearts ineffective contractions cause blood to pool in the atria. This can increase the risk of clotting.
As a result, you may experience:
- shortness of breath
- low blood pressure
- chest pain
During an episode of AFib, your pulse may feel like its racing, beating too slowly, or beating irregularly.
How Is Afib Related To Stroke
AFib increases a persons risk for stroke. When standard stroke risk factors were accounted for, AFib was associated with an approximately fivefold increased risk of ischemic stroke.6 AFib causes about 1 in 7 strokes.7
Strokes caused by complications from AFib tend to be more severe than strokes with other underlying causes. Strokes happen when blood flow to the brain is blocked by a blood clot or by fatty deposits called plaque in the blood vessel lining.
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Physical Activity And Af
The nature of the relationship between leisure time physical activity and AF followed a J-shaped pattern . In the main multivariable model, moderately active individuals had a 19% lower risk of any AF than those reporting low activity . The HRs for paroxysmal/persistent and permanent AF varied slightly from those for any AF. Highly active individuals had similar risk of any, paroxysmal/persistent, or permanent AF as the low activity group. Vigorously active individuals showed a non-significantly higher risk of AF than the low activity group , although they had a significantly higher risk when analysing permanent AF separately . Adding RHR produced virtually similar results as the main multivariable model . Occupational physical activity was not related to risk of AF . Adjusted cumulative risk of AF according to leisure time physical activity during follow-up is displayed in Figure .
Adjusted probability of AF in relation to physical activity.
When Should I Call 911
Atrial fibrillation can cause serious medical complications. So, its essential to learn the warning signs and to share them with your family and friends. In many cases, we need someone else to call 911 for us. Immediately call 911 if you have the following symptoms or if you notice them in someone around you:
Signs of bleeding
- Nausea and vomiting.
- Feeling dizzy or lightheaded.
These symptoms can happen within an hour before having a cardiac arrest. In some cases, these symptoms might not appear at all, and a person could simply faint. If you or a loved one have Afib, its a good idea to talk with your healthcare provider about how to get help in medical emergencies. For those who live alone or spend lots of time alone, there may be no one home to call for help. Medical alert devices may be a life-saving resource.
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How To Enable Irregular Rhythm Notifications
Expert Care For This Common Type Of Irregular Heartbeat
Atrial fibrillation, or AFib, is the most common type of arrhythmia , in which the hearts two upper chambers do not beat in sync with the two lower chambers. Our patients sometimes describe it as feeling like theres a fish jumping in my chest.
A normal heart rate for adults ranges from 60 to 100 beats a minute. If you have atrial fibrillation, your heart may beat much faster, up to 100 to 175 times a minute, or much slower.
Although AFib by itself is not life-threatening, it can increase your risk of stroke and heart failure if not treated. In fact, it causes about 20 percent of all strokes because blood pools in the heart chambers and clots form.
AFib is the most common type of arrhythmia, affecting more than 5 million people in the U.S.a figure that keeps growing as the population ages. Our Cardiac Electrophysiology Program is a national leader in performing ablation procedures, such as cryoablation procedures, for AFib management. We also have the mid-Atlantics most experienced facility using the WATCHMAN device, which can prevent blood clots from forming and causing strokes in patients.
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Blood Thinning Medications To Reduce Your Risk
Anticoagulant medications are the main treatment given to reduce your risk of stroke with atrial fibrillation. They reduce your risk of stroke by slowing down the clotting process, and making a clot less likely to form.
Anticoagulants: benefits and risks
Benefits: anticoagulants help to protect your brain by reducing your chance of a stroke. If you have already had a stroke or transient ischaemic attack , anticoagulants for AF could help you reduce your risk of another stroke while you continue your recovery.
Risks: because anticoagulants reduce clotting, this can make you bleed more than usual if you have an injury. It can also cause bleeding inside your body, including the digestive system and brain.
To help you decide on the right treatment, your doctor will discuss the risks and benefits of medication with you. This includes your individual health, and your stroke risk score.
Because your stroke risk can change over time, you should be regularly reassessed, and your treatment will be monitored at least once a year. You may have regular tests while you are taking certain types of anticoagulant.
High And Low Heart Rate Notifications
If your heart rate remains above or below a chosen beats per minute , your Apple Watch can notify you. These notifications are available only on Apple Watch Series 1 or later for ages 13 and up.
You can turn on heart rate notifications when you first open the Heart Rate app on your Apple Watch, or at any time later from your iPhone:
Learn from the American Heart Association about what can cause a high heart rate or a low heart rate.
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Does Bradycardia Require Treatment
If your heart rate is slow, but you dont have symptoms, theres no reason to worry. However, its a good idea to know the signs of trouble because bradycardia in some cases does require treatment.
For example, if your heart rate drops into the 30s, you might not get enough oxygen to your brain, making fainting, lightheadedness, and shortness of breath possible. Blood can also pool in your heart chambers, causing congestive heart failure.
How Is Atrial Fibrillation Diagnosed
To diagnose atrial fibrillation, your healthcare provider will first ask you some questions. Youll share information about your diet and physical activity, family history, any symptoms youve noticed and risk factors. Its OK if you dont know all the answers but share as much as you can. Your experiences and knowledge are essential tools to help your provider make a diagnosis. Your provider will then give you a physical exam that includes:
- Listening to your heart rhythm with a stethoscope.
- Checking your pulse and blood pressure.
- Checking the size of your thyroid gland to identify thyroid problems.
- Looking for swelling in your feet or legs to identify heart failure.
- Listening to your lungs to detect heart failure or infection.
This exam will help your provider understand your baseline health and how your body is functioning.
Tests to diagnose atrial fibrillation
In addition to the physical exam, your provider may run some tests to make an atrial fibrillation diagnosis. These tests include:
In some cases, your provider may want to check how your heart works in your daily life. If so, youll be asked to wear a Holter monitor or a portable event monitor to record your hearts activity.
An EKG records your hearts electrical impulses and can show if you have atrial fibrillation.
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