"His palms are sweaty, knees weak, arms are heavy
There's vomit on his sweater already, mom's spaghetti
He's nervous, but on the surface he looks calm and readyÉ." Lose Yourself lyrics Ð Eminem.

Do you remember this song by legendary rapper Eminem in the movie "8 Mile"? I do. It's probably the only part I have put to memory and a perfect way to remember some of the common symptoms experienced by your patient in atrial fibrillation (Afib or AF). Perhaps not as extreme as vomiting his "mom's spaghetti" because the range and severity of symptoms and extent of changes in heart rate and rhythm at diagnosis can vary widely.

Normally, the heart maintains a regular beat. Atrial fibrillation is the most common type of irregular heartbeat. The abnormal firing of electrical impulses causes the atria (the top chambers in the heart) to quiver (or fibrillate). Fluttering and palpitations are key symptoms of AF and is the key difference, but many heart problems have similar warning signs. (1) Prior to initiating treatment for AF, consider if the patient has a reversible underlying non-cardiac condition, such as pulmonary embolism, hyperthyroidism or excessive alcohol consumption, causing their symptoms and changes in heart rate, or clinical evidence of a cardiac condition that may have contributed to the development of AF, e.g. myocardial ischaemia.

The risk of stroke is increased four to five-fold in patients with atrial fibrillation, but this can be greatly reduced with the use of anticoagulants.(2)

Prescribing medicines to control heart rate or restoring sinus rhythm is the first-line approach for improving symptoms in most patients with atrial fibrillation.

For any patient with known AF, it is imperative that you teach them and those close to them the early signs of stroke. Patients with AF have an increased risk of thromboembolism, including stroke or systemic embolism. In addition, patients with AF typically experience strokes that are more severe than those which occur due to other causes.3
Stroke Warning Signs
Spot a stroke F.A.S.T.:

¥ Face Drooping: Does one side of the face droop or is it numb? Ask the person to smile.
¥ Arm Weakness : Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
¥ Speech Difficulty: Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence, like "the sky is blue." Is the sentence repeated correctly?
¥ Time to call 9-1-1: If the person shows any of these symptoms, even if the symptoms go away, call 9-1-1 and get them to the hospital immediately.

Video of Stroke warning signs.

We hope you find this article interesting and for more information on atrial fibrillation we have the below links to further educate you.
1. https://www.heart.org/en/health-topics/atrial-fibrillation/what-are-the-symptoms-of-atrial-fibrillation-afib-or-af
2. EHRA Scientific Committee Task Force, Gorenek B, Pelliccia A, et al. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace 2017;19:190Ð225.http://dx.doi.org/10.1093/europace/euw242
3. Freedman B, Potpara TS, Lip GYH. Stroke prevention in atrial fibrillation. Lancet 2016;388:806Ð17. http://dx.doi.org/10.1016/S0140-6736(16)31257-0