💓 Men's Health
Atrial Fibrillation in Nigeria
The most common heart rhythm problem — and a leading cause of stroke
Atrial fibrillation (AF) is an irregular, often rapid heart rhythm caused by disorganised electrical activity in the upper chambers of the heart. It is the most common sustained cardiac arrhythmia globally and is markedly underdiagnosed in Nigeria. AF causes 25–30% of all strokes — including devastating strokes in people who had no idea their heart was in an abnormal rhythm. Detecting and treating AF prevents stroke.
Signs and Symptoms
✓ Palpitations — awareness of an irregular, fast, or fluttering heartbeat
✓ Breathlessness — especially on exertion
✓ Fatigue and exercise intolerance
✓ Dizziness or lightheadedness
✓ Chest discomfort
✓ In some: completely asymptomatic — discovered incidentally on ECG or pulse check
✓ Stroke may be the first presentation of undiagnosed AF
When to Seek Help
Irregular pulseFeel your pulse for 30 seconds. If it is irregular (not just fast — but beats that are not evenly spaced), get an ECG. This is the simplest way to screen for AF.
Palpitations with breathlessness or dizzinessSymptomatic AF needs urgent assessment — rate control and anticoagulation are needed.
New stroke with no obvious causeAF must be excluded with a 24–72 hour cardiac monitor in all unexplained strokes — it may be intermittent (paroxysmal).
Thyroid symptoms with palpitationsHyperthyroidism causes AF — TSH must be checked in all new AF.
Tests & Diagnosis
🧪 ECG
Diagnostic — shows characteristic irregularly irregular rhythm with absent P waves and irregular QRS complexes.
🧪 24-hour or 7-day Holter monitor
For paroxysmal (intermittent) AF not captured on a resting ECG.
🧪 Echocardiogram
Assesses cardiac structure and function — looks for rheumatic valvular disease, left atrial enlargement, and thrombus (clot) in the left atrial appendage.
🧪 Thyroid function (TSH)
Hyperthyroidism is a reversible cause of AF — must be excluded in all cases.
🧪 Renal function and electrolytes
Before starting anticoagulation and for drug dose guidance.
🧪 CHA2DS2-VASc score
Calculates stroke risk — guides anticoagulation decisions. Score of 2 or more in men (3 or more in women) warrants anticoagulation.
Frequently Asked Questions
If AF is not causing symptoms, do I still need treatment?
Yes — the stroke risk from AF is present regardless of symptoms. Many devastating strokes occur in people who did not know they had AF. Anticoagulation is decided based on stroke risk (CHA2DS2-VASc score), not symptoms.
Is warfarin safe for long-term use in Nigeria?
Warfarin is effective but requires regular INR monitoring (monthly or more frequent) — this is often difficult in Nigeria. Non-valvular AF is better treated with DOACs (apixaban, rivaroxaban) which require no monitoring and have better efficacy and safety profiles. DOACs are now available in Nigeria but more expensive than warfarin.
Can AF be cured?
Paroxysmal AF in young people without significant structural heart disease can sometimes be cured by catheter ablation (50–80% long-term success). Persistent AF in older patients with heart disease is managed rather than cured. Treating the cause (hyperthyroidism, alcohol) occasionally leads to spontaneous resolution.
How do I check my pulse for AF?
Place two fingers (not the thumb) on the inside of your wrist below the thumb. Count the beats for 30 seconds and multiply by 2 (gives beats per minute). A normal pulse is regular — beats are equally spaced. In AF, beats are randomly spaced — like rain on a tin roof rather than a clock. Smartwatches can now detect AF reliably.
Is rheumatic heart disease a common cause of AF in Nigeria?
Yes — rheumatic mitral stenosis is a particularly important cause of AF in Nigerian women (from childhood streptococcal infection left untreated). Mitral stenosis + AF is especially high risk for stroke — anticoagulation with warfarin (not DOACs) is essential in this combination.