Stroke Risk Surges with Coexistence of Atrial Fibrillation and Heart Failure; Weight Changes and Low-Salt Diet are Key

Although atrial fibrillation and heart failure are different diseases, they share a close relationship where the occurrence of one can trigger or exacerbate the other. In particular, because the risk of stroke increases significantly when these two diseases coexist, accurate diagnosis and consistent management are more important than anything else.

According to a video from the health medical specialty channel HiDoc, atrial fibrillation is a type of arrhythmia where the atria quiver irregularly, and heart failure refers to a state where the heart's contraction or relaxation function is impaired. Dr. Eom Sang-yong, a specialist in cardiology at Asan Heart Internal Medicine Clinic, explains that these two diseases form a vicious cycle of mutual influence.

Interaction between Atrial Fibrillation and Heart Failure and Stroke Risk

When atrial fibrillation occurs, the heart's contraction efficiency drops, which can lead to heart failure. Conversely, in cases of heart failure, the left ventricular filling pressure of the heart increases; if this pressure is transmitted to the atria, the atria may stretch over time. During this process, deformations occur in the gaps between heart cells, and abnormalities in electrical conduction can trigger arrhythmias such as atrial fibrillation.

The risk of stroke is also high in both diseases. In patients with atrial fibrillation, blood can pool inside the heart, leading to the formation of blood clots (thrombi), which increases the risk of stroke. Even for atrial fibrillation patients without heart failure, the connection between the two diseases is so deep that the 'CHA2DS2-VASc' system used to evaluate risk factors includes a heart failure item. It is also known that heart failure patients, even without atrial fibrillation, have a stroke risk that is 2 to 4 times higher compared to the general population, depending on the study. If atrial fibrillation and heart failure appear simultaneously, that risk increases even further.

Types of Heart Failure and the Importance of Echocardiography for Diagnosis

Heart failure is divided into acute and chronic depending on the timing of symptom onset and the cause. Chronic heart failure occurs when functions gradually decline due to pre-existing heart diseases such as hypertension, coronary artery disease, or arrhythmia, while acute heart failure occurs suddenly due to rapid causes such as myocardial infarction, acute malignant arrhythmia, or acute myocarditis.

Echocardiography plays a key role in diagnosing heart failure. Unlike an electrocardiogram (ECG), it allows for the direct visual confirmation of the heart's structure and function, making it very important for differentiating the causes of heart failure and evaluating the response to drug treatment. For chronic heart failure patients, if their condition is stable, follow-up examinations are recommended every 6 months to 1 year; however, if a patient's symptoms change, they must undergo an examination immediately to check the cause and condition.

Three representative symptoms that may suggest heart failure are dyspnea (shortness of breath), chronic fatigue, and edema (swelling). Dyspnea mainly worsens during activity and is characterized by symptoms becoming more severe when lying flat while sleeping at night. Additionally, due to the decline in the heart's pumping function, blood and oxygen supply to the entire body may not be smooth, leading to unexplained chronic fatigue, and edema may appear as the body swells depending on the kidney condition.

Anticoagulants for Stroke Prevention and Three Major Lifestyle Management Methods

For patients with both atrial fibrillation and heart failure, the prescription of anticoagulants (NOAC) is essential to prevent stroke. Anticoagulants prevent the formation of blood clots by stopping blood from clotting, thereby preventing strokes, but because of their nature of preventing blood from clotting, the risk of bleeding may increase, so one must carefully watch for any signs related to bleeding.

There are three key lifestyle management methods to practice in daily life. First is a low-salt diet. Salt can cause water to accumulate in the body, putting a burden on the kidneys and straining the heart. Second is regular aerobic exercise. In the past, avoiding exercise was sometimes recommended, but currently, regular exercise within a range that does not strain the body is of great help in improving the quality of life. Third is weight management. It is important to have the habit of weighing oneself at a similar time every morning. This is because an unexplained increase in weight may be a signal that water is accumulating in the body and putting a burden on the heart.

The most important point is not to arbitrarily stop prescribed medications. As a rule, heart failure medications should not be discontinued even after kidney function has improved. If a patient arbitrarily stops medication due to discomfort, heart failure may worsen, or in the case of stopping anticoagulants (NOAC), cases occur where patients visit the hospital due to a stroke, so increasing medication adherence is more important than anything else.