A stroke can sometimes appear without warning, but in many cases, the underlying cause has been present for years. Atrial fibrillation is one such condition, quietly increasing risk while often remaining undiagnosed.
Dr Hartini Mohd Yusof, Consultant in Cardiology, Electrophysiology and Internal Medicine at Oriental Melaka Straits Medical Centre, says the condition is still not receiving the attention it warrants. “Atrial fibrillation increases the risk of stroke by up to five times, yet it is one of the most preventable causes of stroke. The challenge is that many patients do not experience symptoms,” she explains.
What is AF?
Atrial fibrillation (AF) is an irregular heart rhythm that disrupts the heart’s normal electrical activity and can increase the risk of blood clots forming. These clots may travel to the brain, leading to an ischaemic stroke. Globally, AF is responsible for around 20 to 30%of ischaemic strokes, while in Malaysia, the Ministry of Health estimates it accounts for 15 to 25%.
One of the key challenges with AF is that it often develops without clear warning signs. The heart may beat too fast or in an irregular pattern, but a significant proportion of patients experience no symptoms at all. Up to 30 to 40% of cases are considered “silent”, meaning the condition may go unnoticed until a serious event such as a stroke occurs.
Because of this, health authorities, including the World Health Organisation (WHO) and the European Society of Cardiology, recommend simple pulse checks as a first-line screening tool.
Diagnosis and Treatment
A screening can be done without any equipment in less than 30 seconds, making it an accessible way to spot potential irregularities early.
A normal pulse is typically steady and falls within a range of 60 to 100 beats per minute. Warning signs include an uneven rhythm, a fluttering sensation in the chest, or an unusually fast or slow heart rate. If any of these signs are present, medical assessment is usually required to confirm the diagnosis. This assessment is typically done through an electrocardiogram (ECG) or longer-term heart monitoring to assess the heart’s rhythm more accurately.
What Happens After Diagnosis
Once identified, AF can usually be managed effectively. The mainstay of treatment is medication known as oral anticoagulants, or blood thinners, which reduce stroke risk by around 60 to 70 per cent.
Newer direct oral anticoagulants are increasingly used as they offer similar protection with a lower risk of serious bleeding in the brain. In selected cases, procedures such as catheter ablation or left atrial appendage closure may be recommended to help control the heart rhythm or reduce stroke risk further.
Who Should Be Alert?
While the risk of atrial fibrillation (AF) increases with age, particularly after 65, younger adults with hypertension, diabetes or existing heart disease are not immune. Because the condition can develop without noticeable symptoms, doctors emphasise the importance of awareness and early detection.
Dr Hartini advises Malaysians to check their pulse regularly, attend routine health screenings, and keep key risk factors such as blood pressure, blood sugar and cholesterol under control. Maintaining a healthy lifestyle through regular physical activity, a balanced diet and avoiding smoking can also help reduce the risk of AF and its complications.
The message from specialists is straightforward: AF is common, often silent, but highly manageable when detected early. A simple pulse check can take less than 30 seconds, yet it may be one of the easiest ways to identify a potentially serious problem before it leads to a life-changing stroke.
