A-Z

Atrial fibrillation

First signs and symptoms of atrial fibrillation

Atrial fibrillation (AF) is a heart condition in which the heart rate is irregular and the pulse rate is faster than normal. People may experience symptoms such as palpitations (a noticeably rapid, strong or irregular heart beat), dizziness, breathlessness and tiredness. Sometimes people have no symptoms at all. We asked Dr Tim Holt, an academic GP, to explain what atrial fibrillation (AF) is, and to describe its symptoms.
 

Dr Tim Holt explains how people with AF have an irregular heartbeat. They may experience symptoms such as palpitations or have no symptoms at all.

Dr Tim Holt explains how people with AF have an irregular heartbeat. They may experience symptoms such as palpitations or have no symptoms at all.

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Atrial fibrillation, is a common condition, particularly in older people and in people with certain other conditions, in which the heart beats irregularly. As well as beating irregularly, it also tends to beat quite fast until the condition is diagnosed and the symptoms are controlled. So it often presents to people with symptoms of palpitations or possibly of dizziness and breathlessness and sometimes a discomfort in the chest but other people get no symptoms at all and sometimes their AF is detected when they’re examined by a doctor or a nurse in the practice or in other situations.

The normal heart rate is, you know, somewhere between perhaps sixty and eighty and in people with atrial fibrillation, it’s often higher than that. Sometimes it can be very high. It can go over a hundred and forty, in which case, it’s quite a serious emergency. Other times it’s much nearer to normal but it’s irregular. That’s the real defining characteristic. It’s not beating in a regular pattern. It’s beating irregularly and, as I say, sometimes that produces symptoms and other times it’s not detected by the patient until they’re examined by somebody.
In our interviews people talked about the way they first experienced AF. For some, the first episode of AF occurred ‘out of the blue’ while they were going about normal everyday activities. Some needed to urinate frequently, others had a dizzy spell at work or experienced symptoms such as palpitations while sitting quietly watching television. Eileen explained how she woke up one morning and discovered she ‘couldn’t stand up long enough to cook breakfast’. George X collapsed in town. David X had an ‘out of body’ experience and ‘strange floating sensations’ while driving.
 

Martin, whose sister has AF, had ‘an inkling’ he might have it too when he had palpitations walking home.

Martin, whose sister has AF, had ‘an inkling’ he might have it too when he had palpitations walking home.

Age at interview: 73
Sex: Male
Age at diagnosis: 71
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Yes, I discovered I was having palpitations in June 2009. I’d been to a meeting of the [town] U3A (University of the Third Age) and I was walking home, which is over a mile, and I suddenly realised my heart rate was very, very fast. And I had an inkling it might be AF because my sister suffers from this. So I took myself to the GP the next day. He gave me a form to take to the local hospital, clinical measurement department, and he said, “When you next get these palpitations, go up there and get them to do an ECG.” Which I did. And a couple of days later I had this experience and I got on a bus, which takes me into the hospital grounds, and fortunately, I was still having the fibrillation when they did the ECG. So that is the only recording they’ve got on a twelve lead ECG of my condition. They sort of panicked at the time and whisked me round to A and E where I spent four hours linked up to another machine, but by the time I’d got in there, it had stopped. 
 

After experiencing palpitations and dizziness one morning, Pauline spent three days in hospital.

After experiencing palpitations and dizziness one morning, Pauline spent three days in hospital.

Age at interview: 69
Sex: Female
Age at diagnosis: 65
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Yes, I woke one Sunday morning, in the summer, four years ago. I’ve always had a bit of a problem with indigestion and I had palpitation, and I got up, dressed and had breakfast, and went to get up from having my breakfast to wash up and, well, really, you know, I was quite dizzy and sat down here on the settee. I knew something was wrong, wouldn’t, my heart palpitations wouldn’t settle down at all. In fact, they got more rapid. Fortunately, we’re here, sheltered accommodation, so I was able to use the intercom and within about, oh, five or ten minutes the paramedics were here, and they wired me up and took me off to the local hospital, where I was given some treatment. I’m not sure what it was but it sorted it out and then I was in, taken into care with a heart consultant, I suppose, although he is a doctor, so I suppose he wouldn’t be, he would be. Anyhow, I spent about four days I think in hospital and I was on medication and was then able to come home.
For others, the onset of AF was associated with physical activities. Keith first had palpitations while playing cricket, Janet found herself ‘getting very, very breathless’ while walking uphill on holiday, and Ginny experienced a ‘pounding heart and a very, very fast pulse’ while mountain climbing which left her legs ‘a bit sort of weak’.
 

Suzy noticed her heart ‘beating quite strongly’ after playing golf but did not realise her symptoms were AF.

Suzy noticed her heart ‘beating quite strongly’ after playing golf but did not realise her symptoms were AF.

Age at interview: 49
Sex: Female
Age at diagnosis: 48
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Yes, so when after being ill, when I first started exercising again after this one particular ‘flu that I had, I played golf and golf was sort of slightly harder work than usual, but I wasn’t paying much attention to it because I was focused on the game, but when I got when I’d get home from these games, I would lie on the sofa and just feel really floored and not feel up to doing anything and a bit surprised and my heart, just could feel my heart beating quite strongly. And just thought, “Oh, I must be, maybe I started playing golf again too soon or something. I still haven’t quite recovered. My heart is sort of labouring a bit.” And I particularly noticed it I think if I’d had a big meal and then was lying on the sofa, rather than a just a short snack. If I kept moving around, I didn’t notice it so much. It was more when I rested that it kicked off. Which I then noticed more after I was diagnosed, I thought, “Ah yeah. That’s exactly what it’s been.” Because I suppose I was getting it more and more often even when I wasn’t ill and that’s why I started noticing things. But it’s amazing how you can have it and not realise it for years on end.
 

Dave first sensed something was wrong while scuba diving when he found himself running out of oxygen.

Dave first sensed something was wrong while scuba diving when he found himself running out of oxygen.

Age at interview: 61
Sex: Male
Age at diagnosis: 50
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I was scuba diving and I’d only just started doing it and a colleague, my buddy, when I came out of the water for the second time in one day when we’d done two dives he said I looked pretty horrible and I was grey and whatever. And we’d had to come out early because I was using so much oxygen and I’d also noticed that, when I stood up quickly, I got dizzy very, very well, more frequently than I’d, you know normally. I mean normally when you stand up quickly you can get dizzy but it was happening almost all the time if I stood up very quickly.
 

When she saw her consultant for the first time, Maggie realised that she’d had symptoms of AF for some time, including palpitations when running up and down the stairs at work.

When she saw her consultant for the first time, Maggie realised that she’d had symptoms of AF for some time, including palpitations when running up and down the stairs at work.

Age at interview: 70
Sex: Female
Age at diagnosis: 61
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He asked me to explain, first of all, how I felt? Had I felt any irregular rhythm? What had I had any symptoms at all? But he also prompted me with all the symptoms rather than my saying to him, “I was very puffed. I was very tired, whatever, at work. Tired at the end of the day.” Because I didn’t know what I was looking for. I went into it completely blind, completely blind and on his prompting of different questions, he I then realised that what he was suggesting or asking me did I have was exactly what I was experiencing. And had been maybe for a good three or four months beforehand. But not really bothered to do anything about it because you you’re busy, work is busy and you, it was summer, it was summer season, hotel industry is busy in the summer so you you’re pushing yourself a lot more than the winter months. Maybe in winter time you would have questioned.

Did you have palpitations?

I did. I did but again, in those days, I didn’t ride lifts very much and I used to run up and down the stairs at work and I’d feel the heart pumping and bumping and if I look back on it now then, yes, I did have palpitations. I would, we had, I had milk delivered and I used to have milk bottles to take out and put in the box. In those times it didn’t come in cartons and the milk bottles would be, you’d carry them and you’d see them pumping on your chest and I never, honestly, thought anything different about them.
Some people saw their GP after becoming aware of a high heart rate while exercising. Paul wore a personal heart rate monitor at the gym, and thought it must be broken. When he borrowed another and his heart rate was still high, he saw his GP. Raymond noticed a high pulse rate while working out and feared he was going to have a heart attack.
 

David Y had his heart rate measured at the gym. When it remained high at rest, he visited his GP.

David Y had his heart rate measured at the gym. When it remained high at rest, he visited his GP.

Age at interview: 67
Sex: Male
Age at diagnosis: 64
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In January 2009, I was attending a gym twice a week and the gym was controlled by qualified physiotherapists, and one of the ladies there, actually come and took my heart rate and it was a hundred and forty. That same day, two hours later, it was still high. It was still a hundred and forty at resting. So my wife immediately told me to go to our GP, which I did, and the GP sent me to a walk-in clinic at the local hospital. They gave me an ECG, told me to get dressed. I got dressed and then they asked me to come and get undressed again and had a second ECG. Well, as a result of the ECG they said I had a problem which I was unaware of. I wasn’t feeling I had a problem because I was I was going to the gym a couple of times a week and I felt fine. 
In some cases people may be unaware of symptoms of AF (asymptomatic). They are diagnosed by chance when they consult their doctor about other health concerns. (For more see ‘Diagnosing atrial fibrillation’ and ‘What having atrial fibrillation feels like’).
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