Atrial fibrillation (AFib) is the most common type of heart arrhythmia. AFib and stroke are closely related. Those with AFib are five times more likely to have a stroke, and one in seven strokes is caused by AFib.
What is AFib?
The heart is made up of four chambers, two atria (upper chambers) and two ventricles (lower chambers). The four chambers of the heart work together to produce a heartbeat. The atria pumps blood into the ventricles between the upper and lower chambers while valves prevent the blood from flowing back into the atria. When the ventricles contract, the blood is pushed out of the heart and the aortic and pulmonary valves close. These actions produce the sound of the heartbeat.
In atrial fibrillation, the upper and lower chambers of the heart don't work together properly, producing an irregular heartbeat, or arrythmia. Instead of contracting normally, the atria make a weak, often rapid, quivering motion that also causes the ventricles to contract abnormally.
AFib and stroke
The weakened, irregular heartbeat seen in AFib allows blood to pool in the atria, which can lead to clot formation. If a blood clot escapes the heart and travels through the body, it can block an artery causing a stroke.
Symptoms of AFib
AFib doesn't always produce symptoms. Some people have AFib and experience no symptoms, but when symptoms are present, they include:
- Irregular heartbeat
- Heart palpitations including a fluttering or pounding sensation in the chest
- Lightheadedness or fainting
- Shortness of breath
- Fatigue
- Chest pain
Risk factors for AFib
Anyone can develop AFib, but there are several factors that increase the risk, including the following:
- Advanced age. The risk of AFib increases substantially with age.
- Obesity. Being overweight increases the incidence, prevalence, severity and progression of AFib.
- High blood pressure. Long term, uncontrolled high blood pressure raises the risk of AFib.
- Heart disease. Those with a history of heart disease are at higher risk of developing the condition, and AFib is the most common complication following heart surgery.
- Moderate to heavy alcohol use has been shown to place individuals at higher risk of AFib.
- Family history. There is a genetic link to AFib. Those with a first-degree family member with AFib have a higher risk of developing the condition.
- Smoking. Current smokers are two times more likely to develop AFib than non-smokers.
- European ancestry. AFib is more common in those of European ancestry than in African Americans.
- Chronic medical conditions such as hyperthyroidism, diabetes, and asthma increase AFib risk.
Goals in managing AFib
After an AFib diagnosis, it is important to set goals in managing the condition. According to the American Heart Association, this may include:
- Returning the heart to a normal rhythm
- Controlling heart rate
- Preventing blood clots
- Managing or reducing stroke risk factors
- Preventing other heart rhythm issues
- Preventing heart failure
Steps to reduce AFib complications
The following lifestyle changes can reduce the risk of complications from Afib:
- Include regular physical activity into your routine
- Follow a heart-healthy diet by reducing sodium, saturated fats, trans fats and cholesterol
- See a doctor for high blood pressure and follow the prescribed regimen for management
- Avoid overuse of alcohol and caffeine
- Stop smoking
- Maintain a healthy weight
Treatment of AFib
The goal of AFib treatment is to restore and maintain a normal heart rhythm and to prevent blood clots from forming in the heart. Treatment options include:
- Medications. Blood thinners and medications to control heart rate and heart rhythm may be prescribed.
- Medical procedures.
- Cardioversion. This is a procedure where an electrical shock is administered under mild anesthesia to reset the heart to normal rhythm.
- Ablation. When medications and cardioversion are not effective or not advised, a minimally invasive ablation procedure may be performed. A catheter is guided through a blood vessel to the heart. The tissue causing the malfunction is then destroyed using radiofrequency laser or cryotherapy, which uses extreme cold to remove abnormal tissues. This results in scarring of the tissue so the abnormal signals can no longer be sent.
- Surgery.
- A pacemaker can be implanted under the skin to maintain a steady heart rhythm. The device detects when the heart is beating too fast or too slow and sends an electrical signal to keep the heart beating at a regular rhythm and speed.
- Open-heart maze procedure. This complex surgery requires a surgeon to make multiple small cuts in the upper part of the heart. The cuts are then stitched together to form scar tissue to block the electrical impulses causing the abnormal rhythm.
Understanding Stroke
Stroke occurs when the arteries that supply blood and oxygen to the heart become blocked (ischemic stroke) or burst (hemorrhagic stroke). AFib increases the risk of ischemic stroke. This emergency situation requires immediate action since brain cells begin to die within minutes, resulting in brain damage, disability or even death. Strokes linked to complications from AFib are often more severe than strokes due to other causes.
Stroke Symptoms
Symptoms of stroke always require immediate medical attention. Call 9-1-1 at the first sign of symptoms. They include the following:
- Sudden numbness or weakness in the face, arm or leg—usually on one side of the body
- Sudden onset of confusion
- Difficulty speaking or understanding
- Sudden difficulty seeing in one or both eyes
- Trouble walking due to dizziness, loss of balance or lack of coordination
- Sudden severe headache with no apparent cause
Atrial fibrillation is a leading cause of ischemic stroke. Early diagnosis of the condition and proper treatment can help in stoke prevention. Managing controllable risk factors and following a prescribed treatment plan can reduce the risk of stroke in those with AFib.
What is dysphagia?
Like aphasia, it can be caused by neurological conditions such as brain injuries and stroke, but it also can stem from muscle disorders, certain cancers and blockages/strictures in the throat.
Depending on the cause, dysphagia can be temporary or long-term.
Conditions commonly associated with dysphagia include:
- Parkinson’s disease and multiple sclerosis
- Neck and throat cancers
- Late-stage Alzheimer’s disease and other dementias
- Cervical neck surgeries
Stages of dysphagia
There are three phases of swallowing that are impacted with dysphagia:
- Oral: This is the process of chewing food and mixing it with saliva to form a bolus in order for it to be moved from the front of the mouth to the back of the mouth. A person with dysphagia in this phase could have trouble breaking down the food enough to properly move it to the back of the mouth to trigger the swallowing reflex. This stage is also where tongue weakness or decreased sensation may impact the ability to clear food from the sides of the mouth causing it to pocket in the cheeks.
- Pharyngeal: This is where the swallowing reflex begins, and pharyngeal muscles push food down the throat to the esophagus. The epiglottis (a cartilage) inverts to protect the airway and sends the bolus towards the esophagus. This is when the upper esophageal sphincter opens to allow food to travel into the esophagus. A person with dysphagia in this phase might feel like the food is “entering the wrong pipe,” Delashaw said, because the muscles in the pharynx and/or larynx are not operating properly to prevent food or liquids from entering the airway.
- Esophageal: This is when the bolus is taken from the upper esophageal sphincter that has opened, allowing it to enter the esophagus. Peristalsis (muscle contractions) carries the bolus from the upper esophagus towards the stomach. In this phase, a person with dysphagia may feel like food is stuck in their throat or chest.
Symptoms of dysphagia
Dysphagia symptoms could include:
- Coughing or choking during or shortly after eating or drinking
- Heartburn or indigestion
- Feeling that food is stuck in the throat or chest
- Painful swallowing
- Regurgitation
- Food sitting in the mouth or being pocketed in the cheeks
- Unexplained weight loss
- Reduced desire to eat
Diagnosing dysphagia
Dysphagia is diagnosed by a healthcare provider. Speech-language pathologists diagnose dysphagia with a comprehensive oral exam and swallowing examination, which should include swallowing tests such as a FEES or MBS exam.
- FEES: FEES stands for fiberoptic endoscopic evaluation of swallowing. This is an exam where a speech-language pathologist inserts a small thin scope with a camera through the nose and allows visualization of the throat, larynx and vocal cords to assess swallow function as you eat and drink certain foods.
- MBS: During a modified barium swallow study, a speech-language pathologist will give you food and liquids covered in a small amount of barium. As you swallow, X-rays are performed to view your swallow in real-time.
Treatment of dysphagia
After a dysphagia diagnosis, a speech-language pathologist can help determine what consistency of food and liquids is safest to eliminate risk of choking or aspiration. They can also provide therapy and exercises to help strengthen the muscles used during the different stages of swallowing.
Treatment should always involve a discussion with the individual to determine their wishes regarding oral intake and development of dysphagia treatment.
“If difficulty is noted in the oral phase, we can design an exercise program to target movement for the muscles used when breaking down the food,” Delashaw said. “Say you had a stroke that impacted lip muscles, and you can’t hold food in your mouth. We’re going to work on increasing the control and strength of the lip muscles, so you do not lose liquids or foods out of the mouth.”
In addition to exercises, Delashaw said neuromuscular electrical stimulation could also be used to increase muscle awareness in the different stages of dysphagia.
In the esophageal stage, your speech-language pathologist could suggest obtaining a referral from your primary care doctor to a gastroenterologist for further evaluation.
Recovery from dysphagia
Depending on the diagnosis and related conditions, dysphagia could improve over time. If swallowing difficulty is related to a neurological condition, inpatient rehabilitation could help develop adaptive techniques and diet plans to meet your needs and quality of life standards.
The multidisciplinary approach in this setting also allows for other symptoms related to your condition to be addressed through intensive therapy. In addition to working with a speech-language pathologist, your therapy team would also include a physical therapist and occupational therapist to address mobility and strength as well as activities of daily living and quality of life.