What Causes Atrial Fibrillation?

Patient Expert

Last time, we were taking an initial tour through atrial fibrillation, the most common heart arrythmia, and learning that while it is more common as we age, it can occur at any time.  A-fib can cause uncomfortable symptoms or none at all, so it is important for us to learn what we can do to recognize this condition and avoid its serious consequences, such as stroke.

What are some of the behaviors and conditions that - by straining the heart - can cause atrial fibrillation? Here are a few of the more major causes:

  • High blood pressure.
  • Coronary artery disease (CAD)
  • Heart Attack.
  • Heart valve disease, especially diseases of the mitral valve.

Other, less common causes that can bring on atrial fibrillation include lung disease, pneumonia, a high thyroid level, heart surgery (this happened to me, something I'll share more about later), heavy alcohol use (having more than three drinks a day over many years can cause long lasting atrial fibrillation.) Even binge drinking a large amount of alcohol at one time can also cause a spell or episode of atrial fibrillation (though this is unlikely to cause persistent afib). Stimulants such as coffee or medications used as decongestants or as diet drugs, nicotine, and cocaine can cause afib.

One of my bouts of atrial fibrillation began about a day and a half after my open heart surgery to repair my mitral valve. As I was recovering in the hospital, I noticed suddenly that I felt very warm and that my chest felt odd and uncomfortable. I was also a bit nauseated.  I wasn't in any pain, but I thought that I should notify the nurse.   She determined that I was experiencing atrial fibrillation. My symptoms were more unpleasant than the first time I had it (which began my journey toward mitral valve repair to begin with.)   This time, instead of some vague discomfort, I felt as if a couple of little animals (possibly squirrels) were running around in my chest. I was told that it is not uncommon to have a bout of afib after open heart surgery, but I was very disappointed.

Later, as I was lying in my room trying to be patient with my weird bongo-beating chest, one of the doctors on my team came in to give me a Metropolol. This is one of several beta blockers that slow down the heartbeat. Beta blockers are valuable in afib treatment when addressing heart rate vs. heart rhythm (the classic rate-rhythm debate which we will explore carefully later.)

I took the small white pill, and within 20 minutes the squirrels had left me for greener parklands and my heart within my chest was calm and peaceful. I was so elated (As was my medical team.)

Only later did I learn that my own beta blocker, propranolol, which I had been taking daily for years, was left out of my medications since the day of the surgery. It was a mistake by the medical team, and it could have been a dangerous one because beta blockers should never be discontinued suddenly, but weaned off of slowly. Thankfully, the one Metropolol (which they then added to my daily meds) solved my post-heart surgery problem, but it was another lesson in paying attention to your own meds and if you are not able to, having a family member or friend there to check them off when the nurse brings them to you in the hospital.

Afib can announce itself very loudly, with rapid heartbeats and gallops, which send many to the emergency room, or it can tiptoe quietly  into your life, just bringing questions about why you might feel tired, or out of breath. In my next blog, I'll share my own experience with afib and the way it turned my life a little upside down, and, ultimately resulted in a life-changing surgery. I'll also be sharing experiences from others who describe just how afib feels and the way it can impact your life.