When you live with atrial fibrillation, or AFib, you may experience a variety of symptoms as a result of the irregular heart rhythm. One of the most common, unfortunately, is fatigue.
This fatigue can be sudden and extreme or a dull tiredness even at rest. Either way, it can be difficult to navigate, especially if you are a 'go-getter' type who's always on the move.
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Fortunately, fatigue from AFib can be managed. Here, learn from cardiologists why fatigue from AFib occurs and get tips for feeling more energized when you're dealing with the heart condition.
What Is AFib?
First things first: AFib is a common type of heart arrhythmia where the upper chambers of the heart (the atria) beat out of sync with the lower chambers (the ventricles), per the Mayo Clinic, causing an irregular or rapid heartbeat.
AFib can be caused by genetics or result from heart damage from heart disease, infection or inflammation, according to the National Heart, Lung, and Blood Institute.
The risk of developing AFib increases as you get older, as does the risk of blood clots, heart attack and stroke if the condition is left untreated.
What Causes AFib Episodes?
AFib can be persistent or occur in episodes, called paroxysmal atrial fibrillation, per the Mayo Clinic.
Things that are likely to trigger an AFib episode include the following, per the University of Michigan Medicine:
- Lack of sleep
- Tobacco use
- Excessive alcohol intake
- Sleep apnea
How Long Does an AFib Episode Last?
Many things factor into how long an AFib episode lasts, including your overall health, family history and the type of AFib you have. If it's paroxysmal AFib, episodes will last about 48 hours without any treatment. If it's persistent, it can go on for longer than seven days, unless treated. And if you have permanent or long-standing AFib, you'll experience symptoms consistently over the course of a year, per the U.K.'s National Health Service (NHS).
Symptoms of AFib
Some people with AFib don't always notice symptoms during an episode. But if you do, common symptoms can include the following, per the Centers for Disease Control and Prevention (CDC):
- Rapid heartbeat (palpitations)
- Chest pain
- Difficulty breathing when lying down or exercising
- Shortness of breath
- Lightheadedness or fainting
- Extreme fatigue
While most of these symptoms subside once the AFib episode has ended (through medical intervention or on its own), the fatigue can be long-lasting and disrupt your daily life.
Why Does AFib Cause Fatigue?
When your heartbeat is out of sync, your heart is not efficient at pumping blood, which may limit oxygen from reaching all your body's cells, per the American Heart Association (AHA).
"With AFib, your heart can't provide enough oxygen to the rest of your body," says Trent Orfanos, MD, a board-certified cardiologist with Case Integrative Health in Chicago. "This lack of 'fuel' can cause you to feel tired and short of breath."
And because AFib is related to a variable heart rate, the fatigue you experience may also come and go, or feel really intense right after an episode, per Johns Hopkins Medicine.
"This also explains why sometimes you feel perfectly fine, but other times symptoms show themselves," Dr. Orfanos says.
So how can you tell the difference between AFib fatigue and your average, everyday tiredness? If the fatigue is disrupting your routine (like your exercise regimen, for example), then it is likely due to your heart condition. Also, if you are experiencing other classic symptoms like lightheadedness, shortness of breath or chest pain, it's most likely AFib fatigue, Dr. Orfanos adds.
Can You Exercise With Fatigue From AFib?
If you are the type to stick to a daily exercise routine, getting diagnosed with a heart condition can be daunting.
But there is research to suggest that keeping a consistent and low-impact workout routine can actually help keep your heart healthy and strong, whether in an AFib episode or not. (Of course, don't push yourself if you are feeling other symptoms like dizziness or chest pain.)
"You absolutely can and are encouraged to exercise despite living with AFib," Dr. Orfanos says.
In fact, an August 2018 study in Clinical Research in Cardiology found that exercising regularly was associated with reduced mortality in people with AFib, and it showed positive improvements to their quality of life.
That said, all exercise programs should be approved by your doctor or cardiologist before beginning, especially if you are actively in AFib or have just come off an episode. The authors of the study above recommend individualized exercises and getting a physical evaluation prior to getting started.
Tips for Exercising With AFib Fatigue
Below are Dr. Orfanos' tips for exercising whether you have persistent or episodic AFib:
- Have a medical check-up before starting exercise, and don't begin until you've been cleared by your doctor.
- Build up gradually, starting with just a short walk daily.
- If you tolerate it well, build up to longer, more challenging and heart-healthy exercises, like cycling or strength-training.
- Keep an eye out for symptoms while exercising.
- Listen to your body and rest when you need it.
- Consult your doctor if you are having a hard time finding the right exercise for you.
7 Tips for Overcoming AFib Fatigue
If you are living with AFib and want to begin exercising (or even just get back to your normal routine), there are steps you can take to deal with any fatigue you may be experiencing. Dr. Orfanos recommends the following:
1. Start With Low-Impact Exercise
Low-impact exercise, like walking or swimming, may be easier than high-impact exercises, such as running or playing basketball, when you're either getting started with a workout routine or dealing with AFib symptoms.
"The most important thing is that you're moving your body," Dr. Orfanos says.
Once you're consistently exercising, try upping the impact level to build your stamina. But make sure to pay attention to your body, and slow down or decrease the intensity if and when you need to.
2. Change the Time of Day You Exercise
Some people may find it difficult to fall asleep at night if they exercise too late in the day (which only increases fatigue), while others find morning exercise wipes them out for the rest of the day. The key here is to tune into your body.
"Some find that their symptoms fluctuate throughout the day, so you can strategize to get that movement in when you're feeling your best," Dr. Orfanos says.
This may mean squeezing a 10-minute workout into a lunch break, or saving longer workouts for the weekends when you have more time to rest afterward.
3. Do Some Breathwork
If you feel stressed from AFib fatigue, practicing breathwork could help.
Deep breathing, according to Harvard Health Publishing, can lower heart rate, stabilize blood pressure and lower stress, making it a great practice for those with AFib.
Dr. Orfanos highly suggests trying breathwork exercises from the nonprofit HeartMath Institute to maintain heart health: Breathe slow, deep breaths, and focus on your heart while thinking of a situation in your life associated with positive emotions.
"Your heart will generate a healthy rhythmic pattern that reduces blood pressure and decreases stress hormones. Practice this regularly and you'll notice positive changes in your mind and body," Dr. Orfanos says.
4. Avoid Triggers
Common triggers for people with AFib include things like lack of sleep, caffeine intake, stress and sleep apnea. Try to get between seven and nine hours of quality sleep each night, limit your caffeine, take steps to manage your stress or avoid stressful situations when possible and get a sleep study done if you or your bed partner suspect you're dealing with sleep apnea.
Alcohol can also be a trigger for AFib, Dr. Orfanos says. Even small amounts (think: one drink) can trigger an AFib episode, per Harvard Health Publishing. Aim to avoid alcohol or limit it to special occasions (get tips here on how to reduce the number of drinks you have per week or per month). And if you do indulge, avoid alcohol before bed, because it can mess with your sleep and increase your fatigue.
5. Focus on Your Diet
When dealing with AFib fatigue (or any fatigue, really), a balanced diet full of nutrient-rich foods can help increase your energy levels.
"A diet free of highly processed foods and sugar with plenty of fruits and vegetables (such as the Mediterranean diet) alone can help increase energy regardless of your underlying condition," Dr. Orfanos says.
6. Take Medication as Prescribed
If you've been prescribed medication for your AFib (like beta-blockers or calcium channel blockers), make sure you are taking them as prescribed by your doctor — whether that's once a day, at night versus in the morning, multiple times a day or as needed.
Many people with episodic AFib also take what's called a 'pill-in-the-pocket.' This is an anti-arrhythmic medication, like flecainide, that's taken as soon as you feel AFib episode symptoms arise, to help stop them, per the NHS.
Sometimes, fatigue can be a side effect of medication. Talk to your doctor if you think meds are the culprit; they can likely switch you to another one.
7. Rest When You Need It
If you've tried all of the above and are still feeling wiped, it's a good opportunity to practice self-care and simply rest. Your body may be trying to tell you it's in need of quality sleep, downtime or a calming activity you enjoy.
Reach out to a counselor or trusted loved one if you're not sure how to properly rest, or if AFib fatigue is taking a toll on your mental health, per the AHA.
When to See a Doctor About Fatigue From AFib
"If you're diagnosed with AFib and find the fatigue unmanageable or interfering with your daily life, talk with your doctor," Dr. Orfanos says.
If, however, you've lived with AFib for some time and already have medication or a routine to help reduce symptoms, you may be able to overcome the fatigue at home. Always reach out to your doctor if you are unsure.
- What is atrial fibrillation?
- Exercise and Atrial Fibrillation: Some Good News and Some Bad News
- Following the Rhythm of the Heart: HeartMath Institute's Path to HRV Biofeedback
- Exercise in Individuals with Atrial Fibrillation
- Michigan Medicine: "7 common Afib triggers that may surprise you"
- Mayo Clinic: "Atrial Fibrillation"
- CDC: "Atrial Fibrillation"
- Case Integrative Health
- NHS: "Atrial Fibrillation"
- American Heart Association: "Why Atrial Fibrillation (AF or AFib) Matters"
- NHS: "Atrial Fibrillation Medications"
- Harvard Health Publishing: "Relaxation techniques: Breath control helps quell errant stress response"
- Harvard Health Publishing: "Alcohol and Atrial Fibrillation"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.