Today is my father’s birthday.  He would have been 92 and although he always said he wanted to live to be 100, it was not to be.  My father suffered from vascular dementia brought on by atrial fibrillation which ultimately led to congestive heart failure.

So today, in honor of my father’s birthday I thought I would post an article on the differences between a heart attack and atrial fibrillation.

Having been a caregiver for my both my father for 4 years and then my mother for a lesser period of time, I’ve come to learn about several health conditions on a fairly intimate basis.  My father suffered from vascular dementia brought on by atrial fibrillation which ultimately led to congestive heart failure. He had several heart attacks, stent placements, a quadruple bypass and insertion of pacemaker with internal defibrillator.  His medications included Digoxin, Lasix, Coumadin and nitroglycerine tablets.

Because he could suffer from angina from either a heart attack or the atrial fibrillation (afib), it became important to know how to tell the difference between  the two or to at least make an educated guess. Knowing the signs and symptoms of each condition can help guide the actions a caregiver takes between the time a 911 call is placed and when emergency responders arrive.

Heart Attack

When a person complains of chest pain, a caregiver’s first thought is often, “heart attack.” A heart attack, or myocardial infarction, occurs when a coronary artery becomes blocked and the heart is deprived of blood and oxygen. This causes the tissues of the heart to die. The longer the heart’s blood supply is interrupted, the more extensive the damage will be.

Although a heart attack can certainly cause chest pain, this is not always the case. Other symptoms that signal a possible heart attack are:

• pressure or heaviness in the chest
• discomfort in the arm, jaw, or throat
•  feelings of fullness or indigestion similar to heartburn
• sweating
• nausea or dizziness
• sudden, extreme weakness
• shortness of breath
• rapid pulse

It is important to note that a heart attack may not trigger all of these symptoms. When symptoms do occur, they typically persist for half an hour or more and are not improved by rest.

What to do:

• plan ahead—keep a current list of your lovedone’s medications and physicians and a copy of their resting electrocardiogram (ECG) where you can get to them quickly and easily
• call 911 and be prepared to provide as much information as possible; stay on the line with the dispatcher until emergency responders arrive and follow any instructions he or she provides
•  if not allergic, ask your loved one to chew and swallow either one (1) regular aspirin tablet or two (2) baby aspirin tablets
• help him or her sit or lie down in a place where emergency responders will have room to take over treatment
• encourage your loved one to take slow, deep breaths

Atrial Fibrillation

Atrial fibrillation (Afib) is the most common type of irregular heartbeat, or arrhythmia. Afib occurs when the top chambers of the heart—the atria—beat erratically and out of sync with the lower chambers—the ventricles. This causes an elevated or irregular pulse, which is oftentimes how patients or their caregivers first discover Afib. During Afib, the heart may not pump blood through the body as well as it should. Depending on how persistent this irregularity is, Afib can be relatively benign or it can contribute to and complicate other conditions such as congestive heart failure, respiratory distress, and edema. While Afib is asymptomatic in some people, it is associated withthe following:

• heart palpitations, or a feeling of fluttering or pounding in the chest
• fatigue
• light-headedness due to low blood pressure
• chest pain or tightness
• shortness of breath, especially when lying flat

Even in the absence of bothersome symptoms, persons diagnosed with Afib require close monitoring. Prolonged Afib leads to fibrosis of the heart muscle and heart failure. Persons with Afib are 5 times more likely to have a stroke, so caregivers should familiarize themselves with common signs of stoke.

What to do:

•  keep a current list of your loved one’s medications and physicians and a copy of their resting electrocardiogram (ECG)
• if chest pain or stroke symptoms—severe headache, dizziness, loss of balance, confusion or trouble speaking, numbness or weakness on one side of the body or face, blurry or darkened vision—are present, call 911, help the person lie down with their head and shoulders elevated, and monitor the their breathing and pulse until emergency personnel arrive
• in the absence of the above symptoms, bring your loved one to the Emergency Room and alert his or her primary physician

The Difference

Many of the symptoms of heart attack and atrial fibrillation overlap. So, how do you tell them apart?

• A person that reports fluttering feelings in their chest is almost always experiencing Afib.
• Afib produces fatigue rather than muscle weakness.
• Low blood pressure suggests Afib, whereas elevated blood pressure is more commonly observed in heart attack patients.

Any time chest pain is present, especially in elderly persons, it should be treated as an emergency.  Quick action by the caregiver can make a huge difference in the loved one’s prognosis. Heart attack and atrial fibrillation can both lead to cardiac arrest. If your loved one experiences cardiac arrest or stops breathing for any reason, check the airway, then perform compression-only CPR until breathing resumes or emergency responders arrive. If your loved one’s physician has prescribed the use of an external defibrillator (AED), follow those instructions.

The Bottom Line

Preparation is important; know what to do in an emergency. If you are caring for an elderly patient, you may want to pursue a Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) certification.

photo credit: JDurham at morguefile.com