Atrial fibrillation etiology and differential diagnosis

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Conduction
Sinus rhythm
Heart conduct sinus.gif
Atrial fibrillation
Heart conduct atrialfib.gif
Atrial fibrillation
SinusRhythmLabels.png
The P waves, which represent depolarization of the atria, are irregular or absent during atrial fibrillation.
ICD-10 I48.
ICD-9 427.31
DiseasesDB 1065
MedlinePlus 000184
eMedicine med/184  emerg/46

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Atrial fibrillation etiology and differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]


Synonyms and related keywords: AF, Afib, fib

Etiology of atrial fibrillation

AF can be associated with underlying cardiac diseases, but it may also occur in otherwise normal hearts.

Common Causes

Complete Differential Diagnosis of Underlying Etiologies for Atrial Fibrillation

As most cases of atrial fibrillation are secondary to other medical problems, the presence of chest pain or angina, symptoms of hyperthyroidism (an overactive thyroid gland) such as weight loss and diarrhea, and symptoms suggestive of lung disease would indicate an underlying cause. A previous history of stroke or TIA, as well as hypertension (high blood pressure), diabetes, heart failure and rheumatic fever, may indicate whether someone with atrial fibrillation is at a higher risk of complications.[1]

Cardiovascular Acute myocardial infarctionCongenital heart disease especially atrial septal defect in adults • Coronary artery diseaseHeart failure (especially diastolic dysfunction and diastolic heart failure) • Hypertrophic cardiomyopathy (HCM) • HypertensionMitral regurgitation

Mitral stenosis (e.g. due to Rheumatic heart disease or Mitral valve prolapse) • MyocarditisPericarditis • Previous heart surgery • Dual-chamber pacemakers in the presence of normal atrioventricular conduction.[2] • Restrictive cardiomyopathies (such as amyloidosis, hemochromatosis, and endomyocardial fibrosis), cardiac tumors, and constrictive pericarditis

Congenital
Dermatologic No underlying causes
Drugs Digoxin in patients with vagally mediated AF
Ear Nose Throat No underlying causes
Endocrine HyperthyroidismHypothyroidismPheochromocytoma
Gastroenterologic Vomiting
Genetic A family history of AF increases risk by 30%.[3] Various genetic mutations may be responsible.[4]
Hematologic No underlying causes
Infectious Disease No underlying causes
Musculoskeletal / Ortho No underlying causes
Neurologic Multiple sclerosis
Nutritional / Metabolic No underlying causes
Oncologic No underlying causes
Opthalmologic No underlying causes
Overdose / Toxicity Excessive alcohol consumption ("binge drinking" or "holiday heart syndrome") • Carbon monoxide poisoningCaffeine • Stimulants
Post-Op Complication Surgery,particularly coronary artery bypass surgery • During pulmonary artery line placement and right heart catheterization trauma to the right atrium can result in atrial fibrillation
Pulmonary Hypoxia of any cause • Lung cancerPneumoniaPulmonary embolismSarcoidosissleep apnea syndrome
Renal / Electrolyte Hypokalemia
Rheum / Immune / Allergy No underlying causes
Trauma ElectrocutionCardiac contusion
Miscellaneous HypothermiaFever

See Also

References

  1. Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, Halperin JL, Le Heuzey JY, Kay GN, Lowe JE, Olsson SB, Prystowsky EN, Tamargo JL, Wann S, Smith SC, Jacobs AK, Adams CD, Anderson JL, Antman EM, Halperin JL, Hunt SA, Nishimura R, Ornato JP, Page RL, Riegel B, Priori SG, Blanc JJ, Budaj A, Camm AJ, Dean V, Deckers JW, Despres C, Dickstein K, Lekakis J, McGregor K, Metra M, Morais J, Osterspey A, Tamargo JL, Zamorano JL (August 2006). "ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation 114 (7): e257–354. doi:10.1161/CIRCULATIONAHA.106.177292. PMID 16908781.
  2. Sweeney MO, Bank AJ, Nsah E, et al (2007). "Minimizing ventricular pacing to reduce atrial fibrillation in sinus-node disease". N. Engl. J. Med. 357 (10): 1000-8. doi:10.1056/NEJMoa071880. PMID 17804844.
  3. Fox CS, Parise H, D'Agostino RB, et al (2004). "Parental atrial fibrillation as a risk factor for atrial fibrillation in offspring". JAMA 291 (23): 2851-5. doi:10.1001/jama.291.23.2851. PMID 15199036.
  4. Saffitz JE (2006). "Connexins, conduction, and atrial fibrillation". N. Engl. J. Med. 354 (25): 2712-4. doi:10.1056/NEJMe068088. PMID 16790707.

Further Readings

  • Fuster V, Rydén LE, Cannom DS, et al (2006). "ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". Circulation 114 (7): e257-354. doi:10.1161/CIRCULATIONAHA.106.177292. PMID 16908781.
  • Estes NAM 3rd, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS, McNamara RL, Messer JV, Ritchie JL, Romeo SJW, Waldo AL, Wyse DG. ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with non valvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Performance Measures for Atrial Fibrillation). Circulation 2008; 117:1101–1120
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