Feeling a sudden fluttering in your chest can be understandably scary, especially if you’ve never dealt with it before. This can be a sign of atrial fibrillation, also known as AFib, which is an irregular heartbeat or arrhythmia. It occurs when the upper chambers of the heart—the atria—are out of sync with the lower chambers and beat chaotically.
“You can think of AFib as an electrical short circuit that can be flipped under the right conditions that put stress on the heart,” says Sharonne N. Hayes, M.D., a cardiologist and the founder of the Women’s Heart Clinic at the Mayo Clinic in Rochester, MN. If you’re at high risk for AFib, that short circuit can be triggered by anything from overconsumption of alcohol to high blood pressure or sleep apnea.
Meet the experts: Sharonne N. Hayes, M.D., a cardiologist and the founder of the Women’s Heart Clinic at the Mayo Clinic in Rochester, MN; Martha Gulati, M.D., a cardiologist at Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles; Shephal Doshi, M.D., board-certified cardiac electrophysiologist and director of cardiac electrophysiology and pacing at Providence Saint John’s Health Center in Santa Monica, CA
And unfortunately, it’s very common. An estimated 10 million Americans are living with AFib, according to the American Heart Association (AHA)—and this isn’t a condition you want to dismiss. Here’s why, plus the surprising signs to look out for.
Is AFib dangerous?
It can be life-threatening: Atrial fibrillation is a leading—and preventable—cause of stroke, and is associated with a five-fold increase in experiencing one. “It also carries a three times increased risk for heart failure and a two-times risk for dementia,” adds Dr. Hayes.
What puts you at higher risk for AFib?
Age is the most important (and, unfortunately, non-modifiable) risk factor for atrial fibrillation, affecting up to 9% of U.S. adults between the ages of 60 and 80. But getting older is not the only contributing factor. Other risk factors of AFib include high blood pressure, diabetes (types 1 and 2), obesity, smoking, alcohol use, an overactive thyroid, and obstructive sleep apnea.
“While AFib is less common in people under the age of 60, these other causes may put you at risk,” says Dr. Hayes. “But most of them are treatable with medication or lifestyle changes.”
What are the warning signs of AFib?
Symptoms of AFib can be vague, intermittent, and all too easy to ignore or discount. “Atrial fibrillation is often confused for anxiety, stress, or a panic attack. You may also think it’s all in your head,” says Martha Gulati, M.D., a cardiologist at Smitdt Heart Institute at Cedars-Sinai Medical Center in Los Angeles. Not only are AFib symptoms easy to miss, but it’s also really common to have the condition without having any red flags at all.
“It’s often hard for patients to know that they’re having atrial fibrillation or another heart arrhythmia,” agrees Shephal Doshi, M.D., board certified cardiac electrophysiologist and director of cardiac electrophysiology and pacing at Providence Saint John’s Health Center in Santa Monica, CA.
That’s why it’s crucial to familiarize yourself with signs that can point to the condition:
Heart palpitations
“Feeling your heart fluttering or beating rapidly is the most common sign of AFib,” says Dr. Gulati. “This arrhythmia can be described as your heart racing, flip-flopping, or pounding. It can come at any time, when you’re exercising, or at rest, or even when you’re sleeping. And the feeling can come and go.” Not all palpitations are atrial fibrillation (or dangerous), but if you notice irregular heartbeats and fluttering, cardiologists want you to be on the safe side and get checked out.
Fatigue and weakness
You may start noticing that you tire easily or faster than usual when exercising. “I have an older patient who is spry and in overall good health, but who felt he was slowing down and getting worn out easily,” says Dr. Hayes. “He was diagnosed with AFib.”
Shortness of breath
Arrhythmia can cause difficulty breathing during normal activities or even at rest. “This symptom can be easily confused with many things, including a panic attack or anxiety,” says Dr. Gulati. “If you feel that something is different, or new, or just doesn’t feel right, go see your doctor.”
Dizziness and light-headedness
An irregular heartbeat can lead to dizzy spells, light-headedness, or even fainting. These SOS signals may seem random or dismissed as dehydration, exhaustion, or anemia, but cardiologists urge you to take anything out of the ordinary seriously and see your doctor.
Chest pain
“This could be anything from a sharp pain or tightness in the chest to a feeling of heartburn,” says Dr. Gulati. “And it can come and go.” This is why patients often think they’re just imagining it, or that it’s just a random incident. The bottom line: “If you have any kind of chest pain or discomfort, it could be your heart and it needs to be evaluated.”
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An underlying medical condition
If you have been diagnosed with a condition like hypertension, sleep apnea, or an overactive thyroid, you are at higher risk for AFib and should have your doctor evaluate you. “If you’ve had a heart attack before, or if you have a sibling or a parent who had AFib early in life, then you should also be evaluated and monitored,” says Dr. Hayes.
No symptoms at all
Like we mentioned, sometimes AFib comes on with no signs. “It’s estimated that about 40% of people with atrial fibrillation are entirely asymptomatic,” says Dr. Hayes. “And this is very consistent with my medical experience. It’s not that you can miss the signs, it’s that you don’t notice any. These are the people I worry about because their AFib may be hidden, and it could cause a stroke.” Dr. Doshi agrees that “a substantial number of people don’t feel AFib.”
This is termed “silent atrial fibrillation” because there are no warning signs. “This is why it’s so critical to keep up with annual physical exams and medical appointments, especially if you’re over 50,” says Dr. Hayes, “because hopefully they’ll pick up on any irregularity when checking your heart rate and blood pressure.”
How is atrial fibrillation diagnosed?
There are a few different ways atrial fibrillation can be identified. If you have symptoms of AFib, your doctor will want to do diagnostic testing since “not all fluttering and palpitations are AFib,” Dr. Doshi says. You can expect your doctor to order one or several of the following heart tests, per the National Heart, Lung, and Blood Institute (NHLBI):
- Electrocardiogram. Also known as an EKG, this quick, painless test helps to record your heart’s electrical activity.
- Blood tests. Blood tests don’t diagnose AFib directly, but they can spot underlying issues that can cause irregular heartbeats. Common ones check for levels of potassium and thyroid hormone. (They can also help your doctor figure out the right medicines for you.)
- Echocardiography. This ultrasound of the heart looks at your heart’s valves, the size of your chambers, and how your heart pumps.
- Cardiac MRI. This imaging test can look at the structure of the left upper chamber of your heart to see how well it’s working. (AFib often originates in this chamber, which is also known as the left atrium.)
Different types of atrial fibrillation
The heart rhythm disorder is generally divided into four categories based on how often someone has it and their symptoms, per NHLBI:
- Paroxysmal atrial fibrillation. This form of AFib is usually brief and can stop within 24 hours. However, it may last up to a week, and it can happen more than once. Symptoms may go away on their own or require treatment.
- Persistent atrial fibrillation. This is AFib that lasts for more than a week. People with persistent atrial fibrillation typically need treatment to regulate their heartbeat.
- Long-term persistent atrial fibrillation. This describes AFib that happens when someone has an abnormal heart rhythm that lasts for more than a year without improvement.
- Permanent atrial fibrillation. AFib is considered permanent when medications and other treatments to restore a normal heart rhythm have not worked.
How is atrial fibrillation treated
If you are diagnosed with AFib, there are effective treatments that can markedly reduce the risk of a stroke—and thus save your life. These can include lifestyle changes like aiming for a healthy weight, limiting alcohol, being physically active, managing stress, and following a heart-healthy diet like the DASH eating plan, per NHLBI.
There are also a range of medications that your doctor can suggest to prevent blood clots, slow your heart rate, and restore your heart’s normal rhythm.
But if medication and lifestyle changes alone don’t impact your symptoms, your doctor may suggest surgical intervention, according to NHLBI.
When to see a doctor
If you have any of the AFib symptoms listed above, or if you have an underlying condition such as hypertension, get checked out by your primary care physician. Even something as simple as taking your blood pressure or listening to your heart during a physical can lead your doctor to pick up on a problem. (“You can also track your heart rate on an Apple watch or a Fitbit, and it can detect potential atrial fibrillation, even if you feel healthy and have no symptoms,” says Dr. Hayes. The good news about these devices is that they can lead you to see a doctor.)
While AFib should always be investigated by a healthcare provider, “you don’t need to run to the ER if you think you have it,” Dr. Doshi says. Instead, he recommends thinking about how you feel overall. “If you feel bad—dizzy and sick—you should go to the ER,” he says. “But if you have occasional symptoms of fluttering, that still definitely warrants a call.”
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