atrial patient fibrillation information · what is atrial fibrillation? atrial fibrillation is...

Atrial Fibrillation

Patient Information

828361 Jan 14-16

Kelowna General Hospital 2268 Pandosy Street 250.862.4300 local 7141

CA R D I AC PRO G R A M

Contents

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Stroke Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Information for people who are taking warfarin (Coumadin®) . . . . . . . . . . . . . . 6

Warfarin and Food: A Guide for Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Information for people who are taking dabigatran (Pradaxa®) . . . . . . . . . . . . . . 8

Information for people who are taking rivaroxaban (Xarelto®) . . . . . . . . . . . . . 9

Information for people who are taking apixaban (Eliquis®) . . . . . . . . . . . . . . . . . 10

What to do if you think you are having an Atrial Fibrillation (AFib) episode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

What you need to know about cardioversion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Self-Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Atrial Fibrillation Zones. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Atrial Fibrillation Self-Care Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Taking a Pulse (Heart Rate) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Atrial Fibrillation: Know Your Colours . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

1 Patient Information

Introduction

What is atrial fibrillation?Atrial fibrillation is pronounced A • tre • al fi • bril • LA • shun, also known as AFib.

AFib is the most common type of heartbeat (otherwise known as heart rhythm) disorder. It makes your heartbeat irregular or uneven. When you have an episode of AFib, your heartbeat is often faster than usual. AFib can come and go, or it can also last for a long time. This uneven heartbeat can cause blood to pool in the heart and form a clot.

How will you feel?Many people do not even realize that they have AFib because they do not feel any symptoms. In fact, AFib rarely requires urgent medical care. Most people with AFib continue to live healthy, active lives.

Some people may have symptoms. The most common feeling is your heart jumping or racing (often called palpitations). This is also described as a fluttering in your chest or skipped beats. These sensations are caused by a rapid or irregular heartbeat.

These are the other common symptoms you may feel. They spell out A-F-I-B (see below).

Who gets AFib?AFib is more common in people who have:

⦁ high blood pressure ⦁ had a previous heart attack ⦁ an abnormal heart valve ⦁ heart failure ⦁ an overactive thyroid gland ⦁ certain lung problems

Risk of strokeAFib increases your risk of stroke since it can cause blood clots to form. The uneven heartbeat causes blood to pool in the heart. If these blood clots break loose they can travel to the brain and cause a stroke. Fortunately, strokes are fairly rare. It is important for your health care provider to assess your personal risk of stroke. The good news is that medicines can lower the risk of stroke.

Anxious (feeling shaky, sweaty

or dizzy)

Fatigue (feeling tired, weak

or faint)

Irregular heart beat

(heart racing or palpitations

Breathing problems

(feeling short of breath)

Atrial Fibrillation 2

AFib treatmentThere are a variety of medicines and treatments for AFib:

⦁ Medicines can be given to slow your heart rate (rate control) or help your heart return to a normal rhythm (rhythm control).

⦁ Medicines can also be given to prevent blood clots from forming and reduce the risk of a stroke.

⦁ Electrical cardioversion is a brief, carefully monitored electrical “shock” to the heart that can also help return your heart to a normal rhythm.

⦁ Catheter ablation is a procedure that can be performed in some individuals to prevent recurrences of Afib.

For more informationYour doctor or other health care provider can talk to you about the choices that are best suited to you.


Treatment

Why treatment is importantTreatment is important because it:

⦁ Reduces your risk of stroke ⦁ Improves your quality of life by decreasing

your symptoms ⦁ Reduces your risk of going to the hospital ⦁ Reduces complications of atrial fibrillation

Most importantly, AFib can be managed using medicines or other treatments. AFib treatments vary from person to person. Your doctor will discuss the benefits and possible side effects with you before making a decision. It is not unusual to try different options until the best option is found.

Medicine options to reduce your symptomsThere are two types of medicines to treat AFib symptoms: rate control medicine and rhythm control medicine. Each of these types of medicines can have different side effects. Not all of them may be right for you. Your doctor will discuss the benefits and risks of each of these medicines with you. Continue to take your medicines even if your symptoms improve or go away. Your medicines reduce your risk of complications related to AFib. Do not stop taking your medicines without talking to your doctor first.

a) Rate control medicinesThese slow your heart rate but do not prevent AFib from occurring. Common types of rate control medicines include:

⦁ Beta-blockers: (Atenolol, Bisoprolol, Metoprolol, Propranolol)

⦁ Calcium channel blockers: (Diltiazem, Verapamil)

⦁ Digoxin

b) Rhythm control medicines These help your heart stay in a normal rhythm or prevent AFib from occurring. Common types of rhythm control medicines include:

⦁ Amiodarone ⦁ Dronedarone ⦁ Flecainide ⦁ Propafenone ⦁ Sotalol

Non-medicine treatment options

Electrical cardioversionElectrical cardioversion is a brief, carefully monitored electrical “shock” to your heart to put it back into a normal rhythm. It is a simple and safe treatment but it does not prevent future episodes of AFib. During a brief anesthetic, a machine called a defibrillator will apply a “shock” to your heart by using two sticky pads that are put on your chest and back. You will get medicines during the procedure to make you sleep and feel comfortable.

Catheter ablationCatheter ablation is a surgical procedure to try to prevent future episodes of AFib. It is fairly effective, but because it is an invasive procedure (surgery), it has risks.

Catheter ablation is suitable for some people with AFib, but not everyone. Discuss the details with your family doctor and cardiologist to find out if this procedure may be suitable for you.


Stroke Prevention

How is atrial fibrillation (AFib) related to stroke?AFib is an uneven heart beat that can cause blood clots to form in the heart. If a blood clot breaks loose it can travel to your brain and cause a stroke. People with AFib are at higher risk for having a stroke than people who do not have AFib. The risk of stroke in people with AFib increases over time. For most people with AFib, the chance of having a stroke is 5 in 100 per year. This means if 100 people have AFib, 5 are likely to have a stroke every year. With proper treatment, the risk of stroke is lowered to about 1 in 100 per year.

Some people have a Transient Ischemic Attack (TIA) before they have a stroke. A TIA (also called a “mini-stroke”) is a brief lack of blood flow to the brain. A TIA is an important warning sign that you are at higher risk for a stroke. Symptoms of a TIA are the same as a stroke, but do not last very long (usually only lasting a few minutes or hours).

Medicines to decrease your risk of strokeThere are two types of medicines that decrease your risk of stroke: antiplatelets (an•ti•plate•lets) and anticoagulants (an•ti•co•ag•u•lants). These are sometimes called “blood thinners”. They decrease your risk of stroke by helping prevent blood clots from forming within your heart that may travel to your brain. However, these medicines may also increase your risk of bleeding. Most patients with AFib should be on one of these medicines. The medicine that is best for you will depend on your risk of stroke.

AntiplateletsAntiplatelet medications prevent the formation of blood clots. When you are wounded, platelets arrive on the scene and group together, forming

a blood clot that stops the bleeding. When an injury involves a break in your skin, this is a good thing. But platelets can also clump when injury to a blood vessel occurs from within the inside, as may happen in an artery affected by atherosclerosis. In this situation, the platelets cause blood clots to develop in an already injured artery. Antiplatelet medications can prevent this process from happening.

Do not combine antiplatelets with another blood thinner unless prescribed by your doctor.

Since these medicines prevent blood clots from forming, their main side effect is bleeding. You may notice a little bit of gum bleeding when you brush your teeth, or that you bleed a bit longer when you cut yourself, but you are still able to stop this bleeding. This is expected. If you notice UNUSUAL bleeding, such as blood in your urine or bloody or black, tarry stools, etc., it is important to contact your doctor right away. Call your doctor immediately if you have a serious fall or hit your head.

Rarely, clopidogrel can cause a rash. Some people complain of diarrhea right after they start taking clopidogrel, which usually goes away on its own.

AnticoagulantsAnticoagulants are generally used for patients with a higher risk of stroke. They work by partially blocking the action of substances in your body that are responsible for blood clotting, called “clotting factors” Common types of anticoagulants include:

⦁ Warfarin (also called Coumadin®) ⦁ Dabigatran (also called Pradaxa®) ⦁ Rivaroxaban (also called Xarelto®) ⦁ Apixaban (also called Eliquis®)

Not all of these medicines may be right for you. Your doctor will discuss the benefits and risks of each of these medicines with you.


Important information about your stroke prevention medicines

⦁ Talk to your doctor or health care provider about your options.

⦁ All these medications significantly decrease your chance of stroke.

⦁ All of these medicines can increase the risk of bleeding. Signs of bleeding can include: nose bleeds, coughing blood, black stool, blood in urine, vaginal bleeding, etc.

⦁ Make sure your health care provider knows all of the medicines you are taking, including non-prescription/over-the-counter medicines. Before taking any new medicines, speak with your health care provider.

⦁ Take all of your medicines exactly as prescribed.

⦁ More information about your medicines will be available from your pharmacist.

What are the signs and symptoms of a stroke?

A stroke can be treated. That is why it is important to know and respond to the warning signs:

Weakness: Sudden loss of strength or sudden numbness in your face, arm or leg, even for a short time.

Trouble speaking: Sudden difficulty speaking or understanding, or sudden confusion, even for a short time.

Vision problems: Sudden trouble with vision, blurred or double vision, even for a short time.

Headache: Sudden severe and unusual headache.

Dizziness: Sudden loss of balance. Dizziness is more serious with any of the other signs and symptoms.

What to do if you have symptoms of a stroke

If you have stroke or TIA symptoms call 9-1-1 right away.If you experience a stroke, it is important to receive treatment right away. Some types of strokes can be treated with medicines that cause blood clots to dissolve, otherwise known as “clot-busting drugs” (Alteplase or tPA). These medicines are given in the emergency department. They must be given right after someone has a stroke (within the first 3 hours) to work.


Information for people who are taking warfarin (Coumadin®)

Why are you taking warfarin?Warfarin helps to reduce the risk of having a stroke by preventing blood clots from forming in your body. Preventing blood clots can make bleeding more likely. It is important to have blood tests to measure how quickly your blood clots. This blood test is called an “INR” (International Normalized Ratio). The INR result is reported as a number. You will need regular INR tests, usually about every 1 to 3 weeks.

What is the right dose for you?The goal INR is 2 to 3 for most people who take warfarin to prevent a stroke. When your INR is in this range, there is no need for a change in your dose. If your INR is less than 2, this means that you are not taking enough warfarin and your dose likely needs to be increased. If your INR is more than 3, this means that you might be taking too much warfarin and your dose likely needs to be decreased. Your doctor (or a member of his or her team) will adjust your dose. Ask questions and ensure you know your INR. It is useful to keep track of your INRs and warfarin doses on a calendar.

What are the side effects of warfarin?The main side effect of warfarin is bleeding. You may notice a little bit of gum bleeding when you brush your teeth, or that you bleed a bit longer

when you cut yourself but you are still able to stop the bleeding. This is expected. If you notice UNUSUAL bleeding, such as a nosebleed that won’t stop with gentle pressure, blood in your urine, or bloody or black, tarry stools, etc., it is important to contact your doctor right away. Call your doctor immediately if you have a serious fall or hit your head.

What else do you need to know? ⦁ Take your warfarin exactly as directed. Do

not adjust your own dose or stop taking it without discussing it with your health care provider first.

⦁ Speak to your pharmacist before taking any new medicines, including over the counter medicines and natural supplements, as many medicines affect the way warfarin works.

⦁ Eat a well-balanced diet. Do not make any drastic changes to your diet without discussing them with your health care provider first, as diet changes can alter the effectiveness of warfarin.

⦁ Be sure to tell all of your doctors, your dentist, pharmacist and all other health care providers that you are taking warfarin. Consider wearing a MedicAlert bracelet or carrying a wallet card that tells people that you are taking warfarin.


Warfarin and Food: A Guide for Patients

Vitamin K Content of Selected FoodsHealth Canada recommends a daily intake of 90 – 120 micrograms (μg) of vitamin K. The total amount of vitamin K you have from day to day may be higher or lower than the recommended amount. It is okay to eat food with different levels of vitamin K, but because vitamin K can interfere with blood-thinning effects of

warfarin, it is important to eat the same amount from day to day. Do not eat a lot one day and none the next. The list below provides information on the vitamin K content of some foods (for a more detailed list refer to website listed below chart). It can be helpful in maintaining a consistent amount of vitamin K in your diet.

This is NOT a list of foods to avoid.

Very High(> 500 μg / 100 g serving)

High(100 – 500 μg / 100 g serving)

Medium(25 – 100 μg / 100 g serving)

Kale Collards Parsley Seaweed Spinach Swiss ChardTurnip GreensGreen Tea

Broccoli (raw) Brussel sprouts (5) Cauliflower (cooked) Chick peas (cooked)Chinese cabbage (cooked) Endive (raw)Lentils (cooked)Mung beans (cooked) Soybeans (cooked) Beef liver

Asparagus (cooked) Cabbage (cooked) Celery (3 stalks raw) Green beans (cooked) Green onions (raw)Green tomato (raw, whole) Lettuce (1 cup raw)Okra (cooked) Watercress (raw) Green apple (1 small) Bok choy (cooked) Pistachio nuts Soybean oil (15 mL) Rolled oatsWheat bran Wheat flour Wheat germ Chicken liver Pork liverCoffee (8 oz / 235 mL)

Vitamin K levels from U.S. Department of Agriculture, Agricultural Research Service. 2005 USDA National Nutrient Database for Standard Reference, Release 18. Nutrient Data Laboratory Home Page, https://www.ars.usda.gov/main/site_main.htm?modecode=12-35-45-00

More information about anticoagulants, vitamin K and your diet is available at the HealthLink BC web site: www.healthlinkbc.ca, or by calling 8-1-1 (Translation services are available in over 130 languages on request. For deaf and hearing-impaired assistance (TTY) call 7-1-1).

For more information sources for patients taking warfarin and their families: Warfarin Resource Guide: Information Sources for Patients www.bcguidelines.ca/pdf/warfarin_management_food_guide.pdf.


Information for people who are taking dabigatran (Pradaxa®)

Why are you taking dabigatran (Pradaxa®)?Dabigatran helps to reduce the risk of having a stroke by preventing blood clots from forming. It does not require blood tests to measure the clotting activity in your body.

What is the right dose for you?The best dose for you will be determined by your doctor. It will depend on your age, whether you have had problems with bleeding in the past, what other medicines you are taking and whether you have any problems with your kidneys. Dabigatran is taken twice daily to prevent a stroke.

What is the main side effect of dabigatran?The main side effect of dabigatran is bleeding. You may notice a little bit of gum bleeding when you brush your teeth, or that you bleed longer when you cut yourself, but you are still able to stop the bleeding. This is expected. If you notice UNUSUAL bleeding, such as a nosebleed that won’t stop with gentle pressure, blood in your urine, or bloody or black, tarry stools, etc., it is important to contact your doctor right away. Call your doctor immediately if you have a serious fall or hit your head.

What else do you need to know? ⦁ Take your dabigatran exactly as directed

by your health care provider. Do not stop taking it without discussing it with your health care provider first.

⦁ Speak to your pharmacist before taking any new medicines, including over the counter medicines and natural supplements, as many medicines affect the way dabigatran works and may increase your risk of bleeding or having a stroke.

⦁ It is very important that you swallow the capsule(s) whole. Do not chew or open the capsule(s). Do not sprinkle the pellets on food or mix with liquids.

⦁ Dabigatran may also cause heartburn. If you are also taking an antacid, it should be separated from dabigatran by at least two hours. Do not take them together.

⦁ If you forget to take a dose of dabigatran, take it as soon as you remember. However, if it is less than 6 hours before your next dose, do not take the missed dose. Simply take your next dose when you are supposed to, and do not take a double dose to make up for the missed dose.

⦁ Be sure to tell all of your doctors, your dentist, pharmacist and all other health care providers that you are taking dabigatran. Consider wearing a MedicAlert bracelet or carrying a wallet card that tells people that you are taking dabigatran.


Information for people who are taking rivaroxaban (Xarelto®)

Why are you taking rivaroxaban (Xarelto®)?Rivaroxaban helps to reduce your risk of having a stroke by preventing blood clots from forming in your body. It does not require blood tests to measure your body’s clotting activity.

What is the right dose for you?There are two doses of rivaroxaban that are recommended for preventing a stroke in people with AFib. The best dose for you will be determined by your doctor. It will depend on things like whether you have had problems with bleeding in the past, what other medicines you are taking, and whether you have any problems with your kidneys. Rivaroxaban is taken once daily to prevent a stroke.

What is the main side effect of rivaroxaban?Since it is used to prevent blood from clotting, the main side effect of rivaroxaban is bleeding. You may notice that you have a little bit of gum bleeding when you brush your teeth, or that you bleed a bit longer when you cut yourself, but you are still able to stop the bleeding. This is expected. If you notice UNUSUAL bleeding, such as a nosebleed that won’t stop with gentle pressure, blood in your urine, or bloody or black, tarry stools, etc., it is important to contact your doctor right away. Call your doctor

immediately if you have a serious fall or hit your head.

What else do you need to know? ⦁ Take your rivaroxaban exactly as directed

by your health care provider. Do not stop taking it without discussing it with your health care provider first.

⦁ Speak to your pharmacist before taking any new medicines, including over the counter medicines and natural supplements, as many medicines affect the way rivaroxaban works and may increase your risk of bleeding or having a stroke.

⦁ Rivaroxaban in a dose of 15 mg or 20 mg daily should be taken with food.

⦁ If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose to make up for the missed one.

⦁ Be sure to tell all of your doctors, your dentist, pharmacist, and all other health care providers that you are taking rivaroxaban. Consider wearing a MedicAlert bracelet or carrying a wallet card that tells people that you are taking rivaroxaban.


Information for people who are taking apixaban (Eliquis®)

Why are you taking apixaban (Eliquis®)?

Apixaban helps to reduce the risk of having a stroke by preventing blood clots from forming. It does not require blood tests to measure the clotting activity in your body.

What is the right dose for you?

The best dose for you will be determined by your doctor. It will depend on your age and weight, whether you have had problems with bleeding in the past, what other medicines you are taking and whether you have any problems with your kidneys. Apixaban is taken twice daily to prevent a stroke.

What is the main side effect of apixaban?

The main side effect of apixaban is bleeding. You may notice a little bit of gum bleeding when you brush your teeth, or that you bleed longer when you cut yourself, but you are still able to stop the bleeding. This is expected. If you notice UNUSUAL bleeding, such as a nosebleed that won’t stop with gentle pressure, blood in your urine, or bloody or black, tarry stools, etc., it is important to contact your doctor right away. Call your doctor immediately if you have a serious fall or hit your head.

What else do you need to know? ⦁ Take your apixaban exactly as directed by

your health care provider. Do not stop taking it without discussing it with your health care provider first.

⦁ Speak to your pharmacist before taking any new medicines, including over-the-counter medicines and natural supplements, as many medicines affect the way apixaban works and may increase your risk of bleeding or having a stroke. Most people should not be taking apixaban with aspirin or other anti-inflammatory pain medications (such as naproxen, ibuprofen, etc). Speak to your healthcare provider if you are taking these at the same time as apixaban.

⦁ If you forget to take a dose of apixaban, take it as soon as you remember. However, if it is less than 6 hours before your next dose, do not take the missed dose. Simply take your next dose when you are supposed to, and do not take a double dose to make up for the missed dose.

⦁ Be sure to tell all of your doctors, your dentist, pharmacist and all other health care providers that you are taking apixaban. Consider wearing a MedicAlert bracelet or carrying a wallet card that tells people that you are taking apixaban.


What to do if you think you are having an Atrial Fibrillation (AFib) episode

Take a few deep breaths – the majority of these episodes settle down on their own. Atrial fibrillation is hardly ever dangerous.

In most cases, you do not have to go to the hospital. Here is what you can do:

⦁ Ensure you have taken your medicines ⦁ If you have instructions for additional

medicines, follow them

Otherwise, sit down, rest and wait 12 or more hours for your symptoms to settle. If you still do not feel better, call your family doctor who may want to adjust your medicines.

But if you still feel the same way 24 hours later, and you have not seen or spoken to a

health care provider, you should go to the hospital or medical provider.

Seek urgent medical care if you feel extremely unwell. For example, if you:

⦁ Cannot stand up or walk across the room ⦁ Feel very short of breath even when sitting

still or when lying down ⦁ Have severe chest pain ⦁ Have a fainting spell

Just remember, AFib is not usually an emergency. Discuss with your doctor what you should do when you have an AFib episode.


What you need to know about cardioversion

What is a cardioversion and why might you need it?A cardioversion is a procedure to restore your heart beat back to its normal rhythm. If your medicines are not working and you have severe symptoms, you may need a cardioversion. A cardioversion may be planned or it may be done on an urgent basis. To see if a cardioversion is right for you, speak to your family doctor or cardiologist about the risks and benefits. A cardioversion may not be right for you if you have other heart conditions or if there is a concern that there may be a blood clot in your heart.

There are two types of cardioversion. Both types of cardioversion do the same thing and your doctor will determine which type is best for you.

The two types of cardioversion are:

Electrical cardioversionElectrical cardioversion is a brief, carefully monitored electrical “shock” given to the heart to change an abnormal heart rhythm back to a normal rhythm. During a short anesthetic, this shock will be applied by a machine called a defibrillator, using two sticky pads that are put on your chest and back. You will get medicines during the procedure to make you comfortable.

Chemical (medicine) cardioversionMedicines are given, usually by injection through a vein but occasionally by mouth, to change an abnormal heart rhythm back to a normal rhythm.


Self-Management

Atrial Fibrillation Internet Sources

Canadian Heart Rhythm Society www.chrsonline.ca

American Heart Rhythm Society www.hrsonline.org

Heart and Stroke Foundation www.heartandstroke.bc.ca

CardioSmart www.cardiosmart.org

Dr. Paul Dorian / St. Michael’s Hospital – Atrial Fibrillation video series www.stmichaelshospital.com/programs/arrhythmia/atrial-fibrillation-videos.php

BC Health Line Call 8-1-1 www.healthlinkbc.ca

Heart and Stroke Canada AFIB Guide www.heartandstroke.ca/AFGuide

Atrial Fibrillation 14 1

Atrial Fibrillation & Exercise: A guide to exercising safely & effectively

What are there benefits of exercise for those with AF?

♥ Exercising regularly may help lower your resting heart rate, improve

exercise tolerance and breathlessness, and improve quality of life

♥ Regular exercise has been shown to decrease the number and severity of AF episodes in those with intermittent AF

Is it safe to exercise with Atrial Fibrillation (AF)?

Yes, once AF is under control and stable, moderate intensity exercise is safe to do. (Resting heart rate is less than 100 beats per minute and no new symptoms like increased shortness of breath or pain).

Why Exercise?

♥ Being active will help reduce your risk of heart disease and stroke;

maintain a healthy weight, reduce high blood pressure, improve blood cholesterol levels, manage stress and improve sugar control for those with diabetes.

♥ Regular aerobic exercise improves your exercise capacity meaning that you can perform your regular daily activities with less effort.

What kinds of exercise are recommended?

Aerobic exercise is any activity that uses large muscles (arms &/or legs) in a rhythm that raises your breathing & heart rate comfortably for longer than 10 minutes. A moderate, steady effort is all that is needed to be beneficial. Make sure that you can talk comfortably during your effort. Examples include walking outside or on a treadmill, biking, hiking, swimming, cross country skiing, rowing, jogging, circuit training. Stretching can be done daily after aerobic exercise when your muscles are warm.

Strength Training (or resistance training) can be added to aerobic exercise to improve your overall fitness. You can use free weights, weight machines, elastic tubing or your own body weight as a resistance to strengthen specific muscle groups. Doing 10-15 movements of each exercise makes a SET. Repeat each SET 1-3 times with rest in between.

15 Patient Information 2

Yoga

♥ Yoga has been shown to be safe and

beneficial for those with AF by decreasing AF episodes and improving quality of life.

♥ Start at beginner level with no inversions (head down) postures. Yoga’s focus on breathing and meditation may be especially beneficial for those with AF.

♥ Caution: “Hot Yoga” may cause heart rate to rise too much in order to cool skin and is not recommended.

Getting Started

♥ Start slowly and build physical activity into your daily routine gradually. Find activities that you enjoy and build on these. Minutes count; even 10-minute bouts are beneficial. If you have not been active at all, consider starting with 5-10 minute intervals.

♥ Remember that with AF, your heart rate may start to climb faster when starting exercise so do a LONG warm up (at least 5 minutes) by starting slowly and gradually building your effort.

Monitoring Heart Rate

With atrial fibrillation, heart rate readings on exercise machines may be unreliable. Further, heart rate targets listed on machines should not be applied to those with heart rhythm problems. It is important to monitor how you FEEL during exercise rather than rely on the heart rate monitor on exercise equipment.

Information produced by

C.O.A.C.H. Central Okanagan Association for Cardiac Health

250-763-3433

March 2015

Atrial Fibrillation 16 3

Frequency- How often should I exercise? • Current Canadian guidelines suggest exercising at a moderate pace 5-7

days per week accumulating > 150 minutes of activity per week.

Intensity- How hard should I exercise? • Heart rate, breathing rate and body temperature should increase but you

should be able to carry on a conversation without having to gasp for air. (Talk Test). A moderate effort that you can sustain comfortably.

• Beta-blocker medications can have a heart rate lowering effect at rest and during exercise. It is best to gauge how hard you are working by using the talk test.

Time- How Long should I exercise for? • Work towards 30-60 minutes per day. When starting a program,

gradually increase the time by about 5 minutes per week • Building up exercise in 10 minute intervals with rests in between is still

beneficial.

Type- What kind of exercise is best? • A combination of aerobic, strength, & stretch exercises throughout the

week is recommended to enhance your overall fitness.

Safety Tips

♥ If you experience any new or unusual symptoms like chest pain, difficulty breathing, or feel of unwell during exercise, stop and consult your doctor or health care professional.

♥ Warm up & cool down: To prevent injury and get the most out of your workout, go at a slower pace for about 5 minutes at the beginning & end of your exercise session to help your body adjust to the change in activity level.

♥ Although exercise is important, it may not be enough to prevent stroke from

AF. Some patients require blood thinners. Patients prescribed blood thinners should use sensible precautions to avoid injury because of the slightly increased bleeding risk on these pills. Use safety equipment such as helmets, walking poles in icy conditions, proper footwear and discuss participating in contact sports with your physician.

Helpful Resources

www.coachkelowna.com www.heartandstroke.ca

www.physicalactivityline.com www.kelownacardiacexercise.ca


Atrial Fibrillation Zones

Which Atrial Fibrillation Zone Are You Today? GREEN, YELLOW, or RED

SafeZone

ALL CLEAR – This zone is your goal!

Your symptoms are under control. You have: ☐ A heart rate (pulse) less than 100 beats per minute. ☐ No palpitations or feelings of a racing heart. ☐ No chest discomfort, pressure, or pain. ☐ No shortness of breath. ☐ No dizziness, light-headedness, or fainting. ☐ No signs of a stroke.

Action: Your condition is stable. Continue to follow your treatment plan and self-care strategies.

CautionZone

CAUTION – This zone is a warning.

You notice a change in your symptoms. Call your Health Care Provider if you have any of the following:

☐ You have more palpitations or feelings of a racing heart than usual. ☐ You feel more short of breath than usual. ☐ You feel more tired and don’t have the energy to do daily activities. ☐ You feel lightheaded or dizzy, and this is new for you. ☐ You feel uneasy, like something does not feel right. ☐ You feel side effects from a medication that treats your AF are intolerable. ☐ Your heart rate (pulse) is faster than 100 beats per minute.

Action: Ask yourself, are you following your treatment plan and self-care strategies? Contact your health care provider: Phone:

DangerZone

EMERGENCY – This zone means act fast.

Go to the emergency room or call 911 if you have any of the following:

☐ You have chest pain that does not go away with rest or medicine. ☐ You feel like you are going to faint. ☐ You are struggling to breathe. ☐ You are having trouble thinking clearly or are feeling confused. ☐ You are having signs of a stroke such as difficulty walking, moving one arm

or leg, or have slurred speech or difficulty talking.

Action: Immediately seek emergency care. Call 9-1-1.


Atrial Fibrillation Self-Care Plan

Atrial Fibrillation Plan for (name)

Your treatment goal ☐ Control your heart rate

☐ Stay in sinus rhythm

Your heart rate (pulse) ☐ Take your heart rate as instructed by

your health care provider

☐ Your target heart rate is

Your blood pressure ☐ Take your blood pressure as instructed

by your health care provider

☐ Your target blood pressure is

Medications ☐ Medications are a key part in managing

the symptoms of atrial fibrillation

☐ It is important to take your medications as prescribed

☐ If you think you need to change your medications or are considering homeopathic treatment for atrial fibrillation, please speak to your healthcare provider first.

Stroke Prevention ☐ Know the following signs of a stroke:

⦁ Sudden numbness, weakness, or paralysis (inability to move) in the face, arm or leg, usually on one side of the body

⦁ Difficulty speaking or trouble understanding others

⦁ Sudden blurred vision or double vision

⦁ Dizziness, loss of balance or loss of coordination

⦁ Sudden, severe headache

☐ If you think you are having a stroke, immediately seek emergency care by calling 9-1-1


Taking a Pulse (Heart Rate)

Checking your pulse on the wristYou can easily check your pulse on the inside of your wrist, below your thumb.

⦁ Gently place 2 fingers of your other hand on this artery.

⦁ Do not use your thumb, because it has its own pulse that you may feel.

⦁ Count the beats for 30 seconds, and then double the result to get the number of beats per minute


Atrial Fibrillation: Know Your Colours

Reprinted with permisssion from the Afib Innovation Program

More information available at:www.knowyourcolours.com

Know Your Colours is a quiz (two short ones actually) for people with atrial fibrillation.

Two important goals in the management of your atrial fibrillation are:

1. reducing your risk of having a stroke (Brain Health)

2. control of your symptoms (Heart Health)

Complete this quiz to find out how well these are being managed. Your doctor wants to improve your care and this quiz can be used as a conversation starter to help you to get and stay on track.

Atrial Fibrillation Do you know your colours?


Find your heart health colourStep 1 Check off all of the statements that apply to you.

I have heart failure or I have been told I have water in the lungs.I have high blood pressure or take blood pressure medicine.I am 65 years of age or older.I have diabetes.I have previously had a stroke or mini-stroke.I am female with angina or peripheral vascular disease.e Do you have any checkmarks in Step 1?

If NO, check off the statement below that best describes you:I am taking Aspirin or blood thinner (dabigatran, rivaroxaban, or warfarin) = Yellow I am not taking blood thinner (dabigatran, rivaroxaban, orwarfarin) = Green

If YES, check off the statement below that best describes you:I am not taking Aspirin or blood thinner (dabigatran, rivaroxaban, or warfarin) = RedI am taking Aspirin (ASA) = YellowI am taking blood thinner (dabigatran, rivaroxaban, or warfarin) = Green

Determine what your colour means

Step 1 1. In the past 4 weeks one or more of the following heart symptoms have bothered me: fast heart rate, irregular heartbeat, shortness of breath, light-headedness, dizziness, chest pain/pressure.

a. Yes, very much b. Yes, somewhatc. No, has not bothered me

2. This past year, I have visited the emergency department and/or had unplanned visits with my family doctor with concerns about my atrial fibrillation:

a. More than onceb. Oncec. Never

Step 2 Determine your results I have all c’s = GreenI have 1 or more b’s and no a’s = YellowI have 1 or more a’s = Red

Red Heart Healt Changes may need to be made to your medications to provide better control of your symptoms. You should ideally follow up with your family doctor within 2 weeks.

Yellow Heart Heal Changes may need to be made to your medications to provide better control of your symptoms. You should follow up on your next visit or within 2 months with your family doctor.

Green Heart Heal The management of your symptoms seems to be good. Keep doing what you’re doing.

Yellow Brain Heal Changes may need to be made to your medications for stroke prevention. You should follow up within 2 months with your family doctor.

Red Brain Healt Changes may need to be made to your stroke prevention medications. You should follow up with your family doctor within 2 weeks.

Green Brain Heal You seem to be on appropriate treatment for preventing a stroke. Keep doing what you’re doing.

Find your brain health colour

Yellow Brain Health

Red Brain Health

Green Brain HealthYellow Heart Health

Red Heart Health

Green Heart Health

Red

RedYellow

GreenYellow

Green

Green

Step 2

Yellow

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