After walking more than 1,500 miles along the famous Camino de Santiago in four years, Ray Rivera recalled boasting to friends about his heart health.  

Then, during a routine checkup in 2015, Rivera was diagnosed with atrial fibrillation (AFib), or an irregular heartbeat. Within a few months, doctors also identified a leaky heart valve and an aneurysm. Surgery in 2016 to replace the valve and to perform an ablation for the AFib also revealed two clogged arteries that required a bypass.

The diagnoses hit Rivera, then 61, hard. He was active, maintained a healthy weight and didn’t have high blood pressure or cholesterol. Although his brother had undergone bypass surgery a few years earlier, Rivera hadn’t realized that family history could mean he was at risk for heart disease or that his age increased his risk for AFib.

“I was going around telling everyone how strong my heart was,” said Rivera, who lives in Pasadena, California. “I just assumed I was fit and heart-healthy.”

AFib Awareness Month

Rivera’s experience isn’t unusual, said John Osborne, M.D., Ph.D, who specializes in treating AFib at State of the Heart Cardiology in Dallas.

“Many AFib patients don’t have symptoms so it’s important, particularly as you get older, to get checked,” said Osborne, who is also an American Heart Association volunteer.

September is National AFib Awareness Month, and the American Heart Association is encouraging people to talk with their medical provider about their risk for AFib and how it may increase the risk of stroke. 

Its prevalence

AFib, which affects more than 2.7 million Americans, occurs when electrical signals in the upper chambers of the heart become chaotic, disrupting the regular rhythm of the heart and its ability to efficiently move blood through its chambers. Left untreated, AFib may increase the risk for stroke by five times and doubles the chance of heart-related death.

“Treatments now are dramatically better than even a few years ago, and most AFib patients can lead a normal life,” Osborne said.

The risks of developing AFib increase with age, affecting about 9 percent of people over age 65. Other risk factors for AFib include uncontrolled high blood pressure, underlying heart disease, family history, obesity and sleep apnea.

Lifestyle factors that could increase your risk of AFib include excessive consumption of alcohol, smoking and prolonged athletic training.

Like many AFib patients, Rivera never noticed any symptoms, which can include a fluttering heartbeat, heart palpitations, light-headedness or feeling winded even while at rest. Other less common symptoms include chest pain and fainting.

Medical solutions

While AFib is treatable, it is important to understand how medications, such as anticoagulants or blood thinners used to reduce the risk of stroke, may affect you in an emergency.

A class of newer medications called direct-acting oral anticoagulants (DOACs) may be safer and more convenient because they do not require as much blood monitoring, have significantly less drug interactions and no food interactions.

“Treatments now are dramatically better than even a few years ago, and most AFib patients can lead a normal life.”

For example, the efficacy of warfarin can be affected by changes in Vitamin K, which is prevalent in green leafy vegetables. Concerns over potential interaction left many patients avoiding important heart-healthy vegetables, Osborne said.

“DOACs are the greatest advance in anticoagulation in the last 60 years,” Osborne said. “Especially for someone who travels, they really make life easier.”

Healthy lifestyle

With a goal of returning to doing pilgrimage walks following his surgery, Rivera pushed himself to walk further each day. While he generally tried to maintain a well-balanced diet, Rivera took steps to make his diet heart-healthy, adding more fruit and vegetables and reducing his alcohol consumption. He also built a strong support system to help him maintain a positive outlook as he weathered the ups and downs of recovery, both physical and mental.

Six months following his surgery, Rivera embarked on 200-mile walk along a pilgrimage trail in France and completed a second one six months later.

“I was worried I’d never be the same, but once I realized I could do it, I wanted to get back out there as soon as possible,” he said.

Take precautions

Rivera, who takes a DOAC to reduce his stroke risk, wears a medical bracelet with crucial information about his condition and alerts any walking companions about where to locate medical details in the event of an emergency. That’s an important precaution, Osborne said, because while DOACs have lower risks, the main side effect of anticoagulants is bleeding.

“If a patient is unconscious, it’s important for medical providers to know if he or she is on an anticoagulant,” he said.

Now 63, Rivera encourages others to recognize their risks for heart disease and talk with their medical provider, even if they think they’re healthy.

“People assume because they have no symptoms, they’re okay, but I’m a perfect example of someone who had a bad heart and no symptoms,” Rivera said.