Atrial fibrillation history and symptoms: Difference between revisions
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| [[File:Siren.gif|30px|link=Atrial fibrillation resident survival guide]]|| <br> || <br> | |||
| [[Atrial fibrillation resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | |||
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{{Atrial fibrillation}} | {{Atrial fibrillation}} | ||
{{CMG}} | {{CMG}} {{AE}} {{Anahita}} | ||
==Overview== | ==Overview== | ||
[[Patients]] with [[atrial fibrillation]] could have a history of [[symptoms]] related to [[atrial fibrillation]], but being [[symptom|asymptomatic]] can not exclude [[atrial fibrillation]]. Indeed, it is not uncommon to identify [[atrial fibrillation]] on a routine [[physical examination]] or [[electrocardiogram|electrocardiogram (ECG)]], as it may be [[symptom|asymptomatic]] in many cases. In [[patients]] who are not [[symptom|asymptomatic]], [[symptoms]] such as [[palpitations]], [[exercise intolerance]] or [[fatigue]], and [[dizziness]] could be reported. [[Symptoms]] such as [[chest pain]], [[dyspnea]], and [[syncope]] could also be seen in more serious cases. It is also important to note that patients with long standing atrial fibrillation might present primarily with symptomatic [[thromboembolic disease]] or symptomatic [[systolic heart failure]] secondary to long standing tachycardia induced cardiomyopathy. | |||
==History== | ==History== | ||
It is important to gather the following information from the patient: | It is important to gather the following information from the [[patient]]: | ||
* The presence and nature of symptoms if any associated with AF. Patients can be grouped into two broad classes: | * The presence and nature of [[symptoms]] if any associated with [[atrial fibrillation]] ([[AF]]). [[Patients]] can be grouped into two broad classes: | ||
:#Those who are entirely asymptomatic | :#Those who are entirely [[symptoms|asymptomatic]] while they have [[atrial fibrillation]] (in which case the [[atrial fibrillation]] is found as an incidental finding on an [[electrocardiogram]] or [[physical examination]]). | ||
:#Those who have clear symptoms and | :#Those who have clear [[symptoms]] and the time at which an episode of [[atrial fibrillation]] begins and when they revert to [[normal sinus rhythm]] could be determined. | ||
* The clinical type of [[atrial fibrillation]] ([[AF]]) (first episode, paroxysmal, persistent, or permanent). | |||
* The clinical type of AF (first episode, paroxysmal, persistent, or permanent). | * The onset of the first [[symptom|symptomatic attack]] or date of discovery of [[atrial fibrillation]] ([[AF]]). | ||
* The onset of the first symptomatic attack or date of discovery of AF. | * The frequency, duration, precipitating factors, and modes of termination (e.g [[vagal maeuvers]]) of [[atrial fibrillation]] ([[AF]]). | ||
* The frequency, duration, precipitating factors, and modes of termination (e.g vagal maeuvers) of AF | * The response to any [[Pharmacology|pharmacological agents]] that have been administered or history of ablation. | ||
* The response to any pharmacological agents that have been administered or history of ablation. | * The presence of any underlying [[heart disease]] or other reversible conditions (e.g., [[hypertension]], recent [[CABG]], [[hyperthyroidism]] or [[alcohol|alcohol consumption]]). | ||
* The presence of any underlying heart disease or other reversible conditions (e.g., [[hypertension]], recent [[CABG]],[[hyperthyroidism]] or [[alcohol]] | |||
==Symptoms== | ==Symptoms== | ||
*Common [[symptoms]] of [[atrial fibrillation]] include:<ref name="pmid24966695">{{cite journal| author=Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S| title=Epidemiology of atrial fibrillation: European perspective. | journal=Clin Epidemiol | year= 2014 | volume= 6 | issue= | pages= 213-20 | pmid=24966695 | doi=10.2147/CLEP.S47385 | pmc=4064952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24966695 }} </ref><ref name="pmid21533828">{{cite journal| author=Meinertz T, Kirch W, Rosin L, Pittrow D, Willich SN, Kirchhof P | display-authors=etal| title=Management of atrial fibrillation by primary care physicians in Germany: baseline results of the ATRIUM registry. | journal=Clin Res Cardiol | year= 2011 | volume= 100 | issue= 10 | pages= 897-905 | pmid=21533828 | doi=10.1007/s00392-011-0320-5 | pmc=3178025 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21533828 }} </ref><ref name="pmid10368121">{{cite journal| author=Lévy S, Maarek M, Coumel P, Guize L, Lekieffre J, Medvedowsky JL | display-authors=etal| title=Characterization of different subsets of atrial fibrillation in general practice in France: the ALFA study. The College of French Cardiologists. | journal=Circulation | year= 1999 | volume= 99 | issue= 23 | pages= 3028-35 | pmid=10368121 | doi=10.1161/01.cir.99.23.3028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10368121 }} </ref><ref name="pmid7496293">{{cite journal| author=Lip GY, Beevers DG| title=ABC of atrial fibrillation. History, epidemiology, and importance of atrial fibrillation. | journal=BMJ | year= 1995 | volume= 311 | issue= 7016 | pages= 1361-3 | pmid=7496293 | doi=10.1136/bmj.311.7016.1361 | pmc=2551280 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7496293 }} </ref> | |||
* [[Palpitations]]. | **[[Palpitations]] | ||
* [[Exercise intolerance]] due to the rapid heart rate | ***[[Palpitation]] has been presented in 42%–55% of [[patients]] with [[atrial fibrillation]]. | ||
* [[Fatigue]] | ***[[Palpitation]] is the prominent [[symptom]] in paroxysmal type of [[atrial fibrillation]]. | ||
* [[Lightheadedness]] | **[[Exercise intolerance]] due to the [[rapid heart rate]] | ||
**[[Fatigue]] | |||
More serious symptoms include the following: | **[[Lightheadedness]] and [[dizziness]] | ||
* [[Chest pain]] if there is underlying atherosclerosis. | **[[Asthenia]] | ||
* [[Dyspnea]], [[shortness of breath]] and [[edema]] if [[congestive heart failure]] is present. | *More serious [[symptoms]] include the following:<ref name="pmid7496293">{{cite journal| author=Lip GY, Beevers DG| title=ABC of atrial fibrillation. History, epidemiology, and importance of atrial fibrillation. | journal=BMJ | year= 1995 | volume= 311 | issue= 7016 | pages= 1361-3 | pmid=7496293 | doi=10.1136/bmj.311.7016.1361 | pmc=2551280 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7496293 }} </ref> | ||
* [[Syncope]]: [[Syncope]] is an uncommon but serious complication that is usually associated with [[sinus node]] | **[[Chest pain]] if there is underlying [[atherosclerosis]]. | ||
* [[TIA]] or [[stroke]]: Sometimes the [[arrhythmia]] will be identified only with the onset of a stroke or a [[transient ischemic attack]] ([[TIA]] | **[[Dyspnea]], [[Dyspnea|shortness of breath]] and [[edema]] if [[congestive heart failure]] is present. | ||
**[[Syncope]]: [[Syncope]] is an uncommon but serious [[Complication (medicine)|complication]] that is usually associated with [[sinus node dysfunction]] or [[Hemodynamics|hemodynamic obstruction]], such as [[Valvular heart disease|valvular]] [[aortic stenosis]], [[hypertrophic cardiomyopathy]], [[cerebrovascular disease]], or an [[Accessory pathway|accessory AV pathway]]. | |||
**[[Dizziness]] | |||
**[[TIA]] or [[stroke]]: Sometimes the [[arrhythmia]] will be identified only with the onset of a [[stroke]] or a [[transient ischemic attack]] ([[TIA]]). [[Stroke]]'s symptoms usually resolve within 24 hours. | |||
*12-25% of [[patients]] with [[atrial fibrillation]] are [[symptom|asymptomatic]], which is called silent [[atrial fibrillation]].<ref name="pmid21533828">{{cite journal| author=Meinertz T, Kirch W, Rosin L, Pittrow D, Willich SN, Kirchhof P | display-authors=etal| title=Management of atrial fibrillation by primary care physicians in Germany: baseline results of the ATRIUM registry. | journal=Clin Res Cardiol | year= 2011 | volume= 100 | issue= 10 | pages= 897-905 | pmid=21533828 | doi=10.1007/s00392-011-0320-5 | pmc=3178025 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21533828 }} </ref><ref name="pmid17367361">{{cite journal| author=Orlov MV, Ghali JK, Araghi-Niknam M, Sherfesee L, Sahr D, Hettrick DA | display-authors=etal| title=Asymptomatic atrial fibrillation in pacemaker recipients: incidence, progression, and determinants based on the atrial high rate trial. | journal=Pacing Clin Electrophysiol | year= 2007 | volume= 30 | issue= 3 | pages= 404-11 | pmid=17367361 | doi=10.1111/j.1540-8159.2007.00682.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17367361 }} </ref> | |||
*There are studies that suggest 1 [[patient]] out of 5 [[atrial fibrillation]] [[patients]] might be [[symptom|asymptomatic]]. <ref name="pmid16908781">{{cite journal| author=Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al.| title=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. | journal=Circulation | year= 2006 | volume= 114 | issue= 7 | pages= e257-354 | pmid=16908781 | doi=10.1161/CIRCULATIONAHA.106.177292 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16908781 }} </ref><ref name="pmid12615792">{{cite journal| author=Page RL, Tilsch TW, Connolly SJ, Schnell DJ, Marcello SR, Wilkinson WE | display-authors=etal| title=Asymptomatic or "silent" atrial fibrillation: frequency in untreated patients and patients receiving azimilide. | journal=Circulation | year= 2003 | volume= 107 | issue= 8 | pages= 1141-5 | pmid=12615792 | doi=10.1161/01.cir.0000051455.44919.73 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12615792 }} </ref> | |||
*[[Symptoms]] such as [[asthenia]], [[dyspnea]] and [[fatigue]] have been observed frequently in permanent [[AF]].<ref name="pmid22949543">{{cite journal| author=McManus DD, Rienstra M, Benjamin EJ| title=An update on the prognosis of patients with atrial fibrillation. | journal=Circulation | year= 2012 | volume= 126 | issue= 10 | pages= e143-6 | pmid=22949543 | doi=10.1161/CIRCULATIONAHA.112.129759 | pmc=3678907 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22949543 }} </ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[CME Category::Cardiology]] | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Up-To-Date cardiology]] | |||
[[Category:Arrhythmia]] | |||
[[Category:Electrophysiology]] | [[Category:Electrophysiology]] | ||
[[Category:Disease]] | |||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
Latest revision as of 04:55, 3 March 2024
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Resident Survival Guide |
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Atrial Fibrillation Microchapters | |
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Special Groups | |
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Diagnosis | |
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Cardioversion | |
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Anticoagulation | |
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Case Studies | |
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Atrial fibrillation history and symptoms On the Web | |
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Directions to Hospitals Treating Atrial fibrillation history and symptoms | |
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Risk calculators and risk factors for Atrial fibrillation history and symptoms | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
Overview
Patients with atrial fibrillation could have a history of symptoms related to atrial fibrillation, but being asymptomatic can not exclude atrial fibrillation. Indeed, it is not uncommon to identify atrial fibrillation on a routine physical examination or electrocardiogram (ECG), as it may be asymptomatic in many cases. In patients who are not asymptomatic, symptoms such as palpitations, exercise intolerance or fatigue, and dizziness could be reported. Symptoms such as chest pain, dyspnea, and syncope could also be seen in more serious cases. It is also important to note that patients with long standing atrial fibrillation might present primarily with symptomatic thromboembolic disease or symptomatic systolic heart failure secondary to long standing tachycardia induced cardiomyopathy.
History
It is important to gather the following information from the patient:
- The presence and nature of symptoms if any associated with atrial fibrillation (AF). Patients can be grouped into two broad classes:
- Those who are entirely asymptomatic while they have atrial fibrillation (in which case the atrial fibrillation is found as an incidental finding on an electrocardiogram or physical examination).
- Those who have clear symptoms and the time at which an episode of atrial fibrillation begins and when they revert to normal sinus rhythm could be determined.
- The clinical type of atrial fibrillation (AF) (first episode, paroxysmal, persistent, or permanent).
- The onset of the first symptomatic attack or date of discovery of atrial fibrillation (AF).
- The frequency, duration, precipitating factors, and modes of termination (e.g vagal maeuvers) of atrial fibrillation (AF).
- The response to any pharmacological agents that have been administered or history of ablation.
- The presence of any underlying heart disease or other reversible conditions (e.g., hypertension, recent CABG, hyperthyroidism or alcohol consumption).
Symptoms
- Common symptoms of atrial fibrillation include:[1][2][3][4]
- Palpitations
- Palpitation has been presented in 42%–55% of patients with atrial fibrillation.
- Palpitation is the prominent symptom in paroxysmal type of atrial fibrillation.
- Exercise intolerance due to the rapid heart rate
- Fatigue
- Lightheadedness and dizziness
- Asthenia
- Palpitations
- More serious symptoms include the following:[4]
- Chest pain if there is underlying atherosclerosis.
- Dyspnea, shortness of breath and edema if congestive heart failure is present.
- Syncope: Syncope is an uncommon but serious complication that is usually associated with sinus node dysfunction or hemodynamic obstruction, such as valvular aortic stenosis, hypertrophic cardiomyopathy, cerebrovascular disease, or an accessory AV pathway.
- Dizziness
- TIA or stroke: Sometimes the arrhythmia will be identified only with the onset of a stroke or a transient ischemic attack (TIA). Stroke's symptoms usually resolve within 24 hours.
- 12-25% of patients with atrial fibrillation are asymptomatic, which is called silent atrial fibrillation.[2][5]
- There are studies that suggest 1 patient out of 5 atrial fibrillation patients might be asymptomatic. [6][7]
- Symptoms such as asthenia, dyspnea and fatigue have been observed frequently in permanent AF.[8]
References
- ↑ Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S (2014). "Epidemiology of atrial fibrillation: European perspective". Clin Epidemiol. 6: 213–20. doi:10.2147/CLEP.S47385. PMC 4064952. PMID 24966695.
- ↑ 2.0 2.1 Meinertz T, Kirch W, Rosin L, Pittrow D, Willich SN, Kirchhof P; et al. (2011). "Management of atrial fibrillation by primary care physicians in Germany: baseline results of the ATRIUM registry". Clin Res Cardiol. 100 (10): 897–905. doi:10.1007/s00392-011-0320-5. PMC 3178025. PMID 21533828.
- ↑ Lévy S, Maarek M, Coumel P, Guize L, Lekieffre J, Medvedowsky JL; et al. (1999). "Characterization of different subsets of atrial fibrillation in general practice in France: the ALFA study. The College of French Cardiologists". Circulation. 99 (23): 3028–35. doi:10.1161/01.cir.99.23.3028. PMID 10368121.
- ↑ 4.0 4.1 Lip GY, Beevers DG (1995). "ABC of atrial fibrillation. History, epidemiology, and importance of atrial fibrillation". BMJ. 311 (7016): 1361–3. doi:10.1136/bmj.311.7016.1361. PMC 2551280. PMID 7496293.
- ↑ Orlov MV, Ghali JK, Araghi-Niknam M, Sherfesee L, Sahr D, Hettrick DA; et al. (2007). "Asymptomatic atrial fibrillation in pacemaker recipients: incidence, progression, and determinants based on the atrial high rate trial". Pacing Clin Electrophysiol. 30 (3): 404–11. doi:10.1111/j.1540-8159.2007.00682.x. PMID 17367361.
- ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA; 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.
- ↑ Page RL, Tilsch TW, Connolly SJ, Schnell DJ, Marcello SR, Wilkinson WE; et al. (2003). "Asymptomatic or "silent" atrial fibrillation: frequency in untreated patients and patients receiving azimilide". Circulation. 107 (8): 1141–5. doi:10.1161/01.cir.0000051455.44919.73. PMID 12615792.
- ↑ McManus DD, Rienstra M, Benjamin EJ (2012). "An update on the prognosis of patients with atrial fibrillation". Circulation. 126 (10): e143–6. doi:10.1161/CIRCULATIONAHA.112.129759. PMC 3678907. PMID 22949543.