If you do have A-fib, you'll need to watch for triggers, such as excessive caffeine, alcohol and stress, which can set off an arrhythmia. "An active, frenetic life makes you secrete stress hormones," says Argenziano. "They can stimulate the heart and work on the electrical signals that trigger A-fib." Other things that can stress or stimulate the heart: cold weather, eating a big meal (which raises insulin levels, blood pressure and heart rate), and intensive exercise or exertion.
Scott Mangum knows all about the latter. He pedals hard — that's what bike racers do — and that day eight years ago was no different. "I was pushing it up a hill," he says. "And then … something was funny. My pulse was unusual. Sort of rapid and irregular."
He didn't think much of it at the time because as soon as he topped the hill and his heart rate dropped, the feeling disappeared. But from then on, whenever he would sprint, he'd feel it again: "After a while, though, my pulse wouldn't go back to normal. That's when I got it checked."
What Mangum, now 56, didn't know at the time, but would learn, is that he may have been setting himself up for A-fib for years. There may be a link — the research is plentiful, but conflicting — between extended, intense exercise and A-fib. "The science shows that middle-aged guys are more susceptible," says Jordan D. Metzl, M.D., author of The Exercise Cure and a sports medicine physician at New York's Hospital for Special Surgery. A 2013 study in the European Journal of Preventive Cardiology showed a fivefold increase in A-fib risk in middle-aged endurance athletes, especially men. Meanwhile, a 2013 study in the journal Circulation: Arrhythmia and Electrophysiology found no "statistically significant association" between normal exercise and A-fib.
The bottom line? If you experience symptoms during exercise, get checked out. But should you stop exercising hard if you're a middle-aged man?
Metzl — age 47 and a veteran of 30 marathons and 11 Ironman triathlons — is frank: "Maybe I'm a candidate for A-fib. I train hard and for many hours. But there's no way for anyone to predict A-fib. Should I curtail my training because of a potential threat? I don't think so. Exercise strengthens your heart. What I know as a doctor is that a stronger heart generally means better outcomes if something bad does happen."
If you are diagnosed with A-fib, don't panic; There are several effective treatment options.
- Medication: Generally, A-fib patients are prescribed two medications. The first is a drug that helps slow the heart and lessen symptoms, even if the arrhythmia is still present. The other is a blood thinner to prevent clots and strokes. "The drugs that slow the heart have side effects like fatigue, loss of energy and impotence in men," says Argenziano. "The thinners can cause bleeding and require close blood testing to keep them in the right range." If they work (as they do for Redford), the side effects can be preferable to symptoms.
- Catheter ablation: This procedure is similar to an angiogram in that the physician feeds a wire into the heart via an artery in the groin. Done right, ablation destroys the abnormal tissue that could be causing the irregular electrical signals by zapping it with an electrical pulse. It worked for Scott Mangum; he's been A-fib-free for several years.
- Surgery: Surgery is very much a last resort, but if you get to that point, it's a relatively low-risk procedure, experts say. It can be open-heart or less-invasive robotic surgery, depending on the patient. The "Maze" procedure inflicts a series of scars, or "dams," in the heart tissue that block faulty electrical signals.
The upshot? If you feel an unusual flutter in your chest, get it checked out. Treatments are effective, but only if you're using them.
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