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When your lifestyle choices disrupt the rhythm of your heart
Statistic reflects the rising burden of cardiovascular disease and the lack of early detection, with many cases remaining undiagnosed until serious complications arise.
At his Nairobi clinic, Dr Daniel Nduiga sees between 100 and 150 patients with heart conditions each month, with at least two of those being newly diagnosed cases of atrial fibrillation (AFib).
AFib is a condition characterised by fast, irregular, and uncoordinated heartbeats.
A decade ago, such cases were rare and primarily seen in elderly patients. Today, however, AFib is appearing more frequently in younger and middle-aged patients, a trend that Dr Nduiga attributes to lifestyle changes.
“Atrial fibrillation becomes much more common with age, affecting around 15 percent of people over 85 years. “But it is no longer just a disease of the elderly; we are now seeing it across different age groups,” he explains.
At Mwai Kibaki Hospital in Othaya, Nyeri County, Dr Karimi Nguchu sees approximately three patients presenting with AFib.
Up to 20 percent of population
He estimates that the condition now affects up to 20 percent of the adult Kenyan population.
This statistic reflects the rising burden of cardiovascular disease and the lack of early detection, with many cases remaining undiagnosed until serious complications arise.
Dr Nguchu has also observed a shift toward younger patients, which is often linked to lifestyle factors such as alcohol consumption, smoking and poor diets. However, the most common risk factors continue to be hypertension, diabetes, coronary artery disease and rheumatic heart disease in children.
“The numbers are clearly rising, partly due to increasing rates of hypertension and diabetes, especially in younger populations, and partly because doctors are now better at detecting AFib due to improved technology,” she says.
Dr Nduiga explains, “This problem originates in the upper chambers of the heart (the atria) and can affect the lower chambers (the ventricles) to varying degrees. This disruption affects how efficiently the heart pumps blood,” he explains.
Often referred to as a 'silent condition', atrial fibrillation can go unnoticed because its effect on the ventricles is often minimal.
However, many patients experience symptoms such as a rapid heartbeat that feels like fluttering, breathlessness, fatigue, coughing when lying down, dizziness when standing up, and weakness.
Dr Nduiga emphasises that sudden headaches, weakness in the arms or legs, facial drooping, slurred speech or difficulty walking should never be ignored as they are warning signs of a stroke, which is one of the most serious consequences of untreated AFib.
“You only notice the condition after something bad has already happened,” adds Dr Nguchu.
“The most serious of these consequences is stroke. When blood stagnates in the atria due to irregular heartbeats, clots can form and travel to the brain. AFib is also associated with fatigue, palpitations, fainting spells and, if left untreated, heart failure.”
At Aga Khan University Hospital, Dr Mohamed Jeilan, Consultant Interventional Cardiologist, has also noticed this trend, stating that AFib has become a “common condition” in cardiac practice.
“Whereas in the past it was sporadic and often incidental in elderly patients, it is now routinely diagnosed in multiple patients during a single clinic day,” he explains.
Dr Jeilan provides a simple explanation of AFib: in a healthy heart, a natural pacemaker instructs the atria to contract and the ventricles to pump blood at a steady rhythm of 60 to 100 beats per minute.
However, in AFib, atrial cells fire signals chaotically—up to 300 to 600 times per minute. This overwhelms the atria, causing them to stop contracting properly and instead quiver. The ventricles receive signals at random intervals, resulting in an irregular and inefficient heartbeat.
“This means that blood doesn't flow smoothly, clots may form and, when these clots travel to the brain, they can cause strokes,” says Dr Jeilan.
Common AFib symptoms
“In younger individuals, AFib may arise from congenital rhythm problems, structural defects such as holes in the heart, or rheumatic heart disease,” she explains.
“In contrast, among older adults—especially those over 50 years—it is frequently associated with high blood pressure, diabetes, or ischaemic heart disease,” explains Dr Nguchu.
Dr Nduiga adds that alcohol misuse is a significant trigger for AFib. He highlights the phenomenon known as 'holiday heart syndrome', whereby consuming more than three beers, or several servings of whisky or wine, can trigger AFib within a matter of days. “This type of AFib is often temporary, but can still cause symptoms,” says Dr Nduiga.
Globally, the incidence of AFib is rising. In Western countries, up to one in three people may be affected. Although Kenya lacks precise nationwide statistics, doctors generally agree that the prevalence is steadily increasing.
Dr Nduiga has observed a clear upward trend in AFib cases, driven by rising rates of hypertension, diabetes, obesity, smoking-related lung diseases and asthma.
Diagnosis and treatment
AFib is diagnosed using a 12-lead electrocardiogram (ECG), which records the heart's electrical rhythms. However, Dr Jeilan points out that, as AFib can be intermittent, short ECGs may miss it.
“That’s why we often use a heart monitor that records activity over 24 to 72 hours for more accurate detection,” he explains.
Once AFib has been confirmed, the focus of treatment is either to restore normal rhythm or to control the heart rate. For rhythm control, cardioversion—an electric shock to reset the heart—may be effective, especially if the arrhythmia is recent. Another option is catheter ablation, in which doctors destroy the abnormal electrical pathways to allow the sinus node to regain control.
“For patients who cannot undergo these procedures, long-term management involves blood thinners to prevent clots and medications to reduce the heart rate or suppress abnormal impulses,” adds Dr Nguchu.
According to Dr Jeilan, treatment can involve controlling symptoms. Medications can help to slow the heart rate and reduce palpitations, while anti-arrhythmic drugs can restore a normal rhythm. However, these medications affect the entire heart and may not be tolerated by all patients.
These medications can cost between Sh2,000 and Sh4,000 per month and carry a risk of bleeding, making them unsuitable for some patients.
Dr Nduiga stresses the importance of also treating underlying conditions such as hypertension, diabetes, obesity and chronic lung disease, which can contribute to the development of AFib.
“We are not only treating the symptoms of atrial fibrillation. We are also addressing the underlying conditions that cause it in the first place,” he states.
Need for awareness
One of the biggest barriers to effective AFib management, Dr Jeilan says, is a lack of awareness.
"Many people live with AFib without realising it until they have a stroke," he says.
The rapid advancement of technology has increased the importance of wearable devices for detection. Smartwatches and other wearables can detect irregular heart rhythms and encourage users to seek medical attention.
For Dr Jeilan, prevention is still the best strategy. He recommends maintaining a healthy weight, exercising regularly, managing blood pressure and diabetes, reducing salt and carbohydrate intake, getting enough sleep, managing stress levels, and avoiding smoking, alcohol and stimulant drugs.
“Weight management, exercise and sleep are among the most effective ways to lower your risk,” he emphasises.
