“Atrial fibrillation (AF) is a rapid, irregularly irregular atrial rhythm. Symptoms include palpitations and sometimes weakness, effort intolerance, dyspnea, and presyncope. Atrial thrombi often form, causing a significant risk of embolic stroke. Diagnosis is by ECG. Treatment involves rate control with drugs, prevention of thromboembolism with anticoagulation, and sometimes conversion to sinus rhythm by drugs or cardioversion.” The Merck Manual (http://bit.ly/1tbbJXQ)
Hello Mr. A, I’m Tim. I’m a medical student. Can I talk to you for a minute?
Hi, nice to meet you. Sure thing.
Mr. A, can you tell me what you know about your heart condition?
They told me that my heart wasn’t pumping right. Something about electricity in my heart is off.
That’s right, you have something called Atrial Fibrillation. The heart is controlled by an electrical impulse that coordinates the efficient pumping of blood throughout your body. However, your heart’s electricity is irregular and is causing your heart to quiver instead. That’s why you are sometimes tired and can feel your heart racing. Also blood is more likely to just sit in your heart and potentially form a blood clot. Our biggest worry is that the clot will travel to other parts of your body and cause damage, such as a stroke. That’s why the doctors prescribed you Coumadin, a blood thinner. The blood thinner reduces the risk of forming a blood clot. Does that make sense?
Yeah…do I have to be on blood thinners for the rest of my life?
Yes, you have a lot of risk factors for developing a clot so you will have to take the medication. However, it is important that you regularly follow up with your primary care doctor to check that the drug levels in your blood are appropriate. If it is too high, it causes excessive bleeding and other problems. Do you have any other questions?
Umm…not that I can think of right now.
It was nice meeting you Mr. A.
One of the assignments in my Emergency Medicine rotation is to pick a disease to discuss with patients who have the disease. It was interesting to see patients who did not understand or understood very little about their disease and attempt to explain to them the pathophysiology and treatment. A short conversation in the Emergency Department with a medical student may have not made a huge difference but I hope that it empowered them a little to take control of their own disease.
