43-year-old Diana from Ede can talk about it. She had been suffering from palpitations for some time and at first her complaints seemed to be explained by the fact that she was pregnant. Moreover, she was divorced a lot later.
Beekhuizen decided to go to the doctor to be sure. “The first question I received was whether I suffered from stress,” says Beekhuizen. “I had, but that alone couldn’t have been it. I felt like my heart was racing.” However, according to the GP, there was nothing remarkable about her blood pressure and heart rate at the time, so she was sent home.
Valve deviation
But the complaints persisted and Beekhuizen returned to the doctor a few more times to no avail. One of those times she insisted on a referral to a cardiologist. “I said I wanted it investigated,” she says. That eventually happened. After a 24-hour investigation, the redeeming answer follows: “It turned out that I had a valve abnormality, which can cause atrial fibrillation.”
There is no clear explanation for why atrial fibrillation is sometimes overlooked, says Rudolf de Boer, cardiologist at Erasmus MC and chairman of the Dutch Association for Cardiology (NVVC). “People can have complaints, but that is not necessary,” says De Boer. “A lot of people have no complaints, but it also happens the other way around: people have complaints, but there is no atrial fibrillation.”
According to the cardiologist, many of the complaints linked to atrial fibrillation, such as dizziness and palpitations, cannot be attributed exclusively to atrial fibrillation. “There are different types of arrhythmias, so when people feel their heart pounding, it could actually be anything. And the treatment for those disorders often differs from that of atrial fibrillation.”
Attack frequency
In addition, atrial fibrillation also occurs in ‘attacks’, which means that a patient may experience complaints during the weekend that do not occur at the GP on Monday, De Boer continues. “It may be that people have a low attack frequency,” says the cardiologist. “But even if an attack only occurs three times a year, atrial fibrillation can occur.”
In practice, a ‘registration’ of atrial fibrillation is therefore decisive for making the diagnosis.
Register atrial fibrillation
If there is a suspicion or further investigation of heart fibrillation, a patient is therefore sent to the hospital for an ECG, an ECG. Sometimes a 24-hour ECG is necessary and if there is possibly a ‘low attack frequency’, the doctor may decide to make ECGs with an ‘event recorder’ or a ‘loop recorder’, which can measure attacks over longer periods.
– Rudolf de Boer, cardiologist Erasmus MC
The fact that the complaints cannot always be measured can make people insecure. “People start to doubt themselves,” says Sanne Ruigrok, researcher at patient association Harteraad. “They may think: ‘I go to the doctor and there appears to be nothing wrong with me’. But that is because the atrial fibrillation is not happening at that moment.” The researcher also makes a comment: “There are also people with very alert doctors who immediately started investigations and then made the diagnosis.”
Stinging pain
61-year-old Klaske Zandstra from Sumarreheide is one of them. She is very satisfied with her doctor and praises how alert she was when Zandstra knocked on the door complaining of a ‘stinging pain’ between her shoulder blades. “I thought: I’ll get some painkillers and then it’s done,” says Zandstra. But when the doctor took a closer look at her, she noticed that Zandstra looked pale.
She then decided to also measure Zandstra’s blood pressure and heart rate. “I thought: what do they have to do with back problems?” Zandstra continues. “It turns out that back pain is often a symptom of heart problems.” The GP found her heart rate worrying enough to send Zandstra straight away in an ambulance to the hospital, where atrial fibrillation was definitively diagnosed.
Hold on a bit
According to researcher Ruigrok, both the doctor and the patient have a task if a patient suspects he or she recognizes symptoms, but does not feel taken seriously. “On the one hand, the doctor must recognize the complaints and on the other hand, the patient must be able to clearly express complaints: what exactly do you experience and when? You must also keep track of that information so that you can enter such a conversation well prepared.”
“On the other hand, it is always possible that the complaints do not match what a doctor knows about atrial fibrillation,” Ruigrok continues. “Then it will last for a while. Maybe you are the one in whom atrial fibrillation manifests itself differently.”
It is important to look for a solution together. “You are the one who knows your body best. No matter how difficult it is, as a patient you can say – without being too firm – that you do not feel taken seriously and that you do not see the doctor’s solution as a solution. The doctor is just a human being with whom you should be able to have a conversation.”
2023-11-14 16:20:59
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