Almost every fourth stroke caused by atrial fibrillation – medical practice

Atrial fibrillation often goes unnoticed: Increased risk of stroke

Atrial fibrillation often manifests itself as a racing heart or palpitations. But only about half of those affected feel symptoms. The arrhythmia therefore often goes unnoticed. However, treatment is important to reduce the risk of stroke.

Every year more than a quarter of a million people in Germany suffer a stroke. A large part of the so-called cerebral infarctions can be traced back to diseases of the blood vessels or the cardiovascular system. Atrial fibrillation, among other things, significantly increases the risk of stroke. The cardiac arrhythmia remains unnoticed by many of those affected.

Complaints only in half of those affected

As the German Heart Foundation writes in a recent press release, a stroke often affects people with atrial fibrillation, who do not know anything about their arrhythmia and have therefore not received protective therapy.

Around a quarter of strokes in this country are due to atrial fibrillation. Only in around 50 percent of the around 1.8 million patients with atrial fibrillation does the cardiac arrhythmia make itself felt with noticeable symptoms such as heart stumbling and heartbeat up to the neck, sensation of pressure in the chest, fear, shortness of breath, dizziness and poor performance.

In the other half, atrial fibrillation usually occurs only atypically or even without any symptoms. “The stroke is the greatest danger posed by atrial fibrillation. Elderly patients over the age of 60, in particular, with frequent cardiovascular diseases such as high blood pressure, diabetes and coronary artery disease, have a high risk of developing atrial fibrillation and should protect themselves, ”says the heart specialist Priv.-Doz. Dr. med. Gerian Grönefeld from the Scientific Advisory Board of the German Heart Foundation.

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This is why the foundation recommends that older people aged 60 and over and those with heart disease also take their pulse regularly. “If the pulse is irregular or if it is more than 100 beats per minute at rest, you should immediately consult a doctor to clarify whether there is atrial fibrillation,” says Grönefeld.

Recognize signs of stroke and get help

Strokes don’t always come out of the blue, however. Individual symptoms often appear days or weeks beforehand, but disappear again after a few minutes. Most of the time, these “harbingers” are almost the same as symptoms of a stroke.

In contrast to a “real” stroke, these warning signals called “transitory ischemic attack” (TIA) disappear after a short time. A TIA, like a stroke, manifests itself through the following symptoms that everyone should be aware of:

  • Symptoms of paralysis on one half of the body: for example, paralysis of an arm or a leg
  • Facial symptoms: drooping corner of the mouth, difficulty smiling
  • Language disorders: suddenly slurred or unclear language, word finding problems, incorrect sentence formation
  • sudden severe headache
  • Visual disturbances up to blindness or dizziness

Anyone who notices one of these symptoms should not hesitate and call 112 immediately. Because the most important thing is not to lose any time.

Treat the underlying disease consistently

The most important first measure after the diagnosis of atrial fibrillation is treatment with an anticoagulant drug (so-called “blood thinners”).

In the heart, in a bulge in the atrium, blood clots can form due to the irregular heartbeat caused by atrial fibrillation. If these are flushed out and get into the head with the bloodstream, they can clog a cerebral vessel: a stroke occurs.

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However, other cardiovascular diseases that can cause atrial fibrillation must also be considered for risk prevention. Therefore, in addition to taking anticoagulant medication, it is just as important to consistently treat the underlying disease of the cardiac arrhythmia.

In addition to high blood pressure, this includes in particular coronary artery disease (CHD), heart valve disease, heart failure, myocarditis (inflammation of the heart muscle), diabetes, thyroid disease, COPD (chronic obstructive pulmonary disease) and obesity (obesity) / overweight.

High blood pressure increases the risk of stroke

About 60 percent of people with atrial fibrillation have high blood pressure. An enlargement of the left atrium is the first sign that the heart has already been damaged by the high blood pressure.

Hypertensive patients should therefore be well adjusted therapeutically in order to minimize their risk of stroke. In the case of high blood pressure, for example, lowering the upper value by just ten mmHg can reduce the risk of stroke by almost 40 percent.

“Patients with high blood pressure and atrial fibrillation are burdened twice: On the one hand, the high blood pressure itself increases the risk of heart attack and stroke due to the vascular stress, and on the other hand, the atrial fibrillation increases the risk of blood clots forming, which in turn can trigger a stroke,” explains Grönefeld.

Reduce risk

Cardiovascular patients and healthy people aged 60 and over should take their pulse at home. This will help you reduce your risk of stroke. Blood pressure monitors usually also show irregularities in the pulse or you can feel your pulse yourself.

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“Even doctors should always feel the pulse first when visiting the practice, especially with high blood pressure and cardiac patients, and take an EKG if anything is abnormal.” So-called “wearables” or “smartwatches” with pulse measurement and EKG functions or apps for smartphones with these can also help Functions.

However, the ECG documentation of the wearables should be assessed by the doctor in order to make the correct diagnosis. (ad)

Author and source information

This text complies with the requirements of specialist medical literature, medical guidelines and current studies and has been checked by medical professionals.


  • German Heart Foundation: Unnoticed atrial fibrillation: Risk of stroke, (accessed: September 26, 2021), German Heart Foundation

Important NOTE:
This article is for general guidance only and is not intended to be used for self-diagnosis or self-treatment. He can not substitute a visit at the doctor.



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