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(New page: {{Template:Atrial fibrillation}} {{CMG}} ==History and physical examination for atrial fibrillation== The history of the individual's atrial fibrillation episodes is likely the most impor...)
 
 
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| <small>Sinus rhythm</small> [[Image:Heart conduct sinus.gif|none|75px]]
| <small>Atrial fibrillation</small> [[Image:Heart conduct atrialfib.gif|none|100px]]
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{{Template:Atrial fibrillation}}
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{{CMG}} {{AE}} {{Anahita}}


==History and physical examination for atrial fibrillation==
==Overview==
The history of the individual's atrial fibrillation episodes is likely the most important part of the evaluation. Distinctions should be made to those who are entirely asymptomatic when they are in atrial fibrillation (in which case the atrial fibrillation is found as an incidental finding on an electrocardiogram or physical examination) and those who have gross and obvious symptoms due to atrial fibrillation and can pinpoint whenever they go into atrial fibrillation and revert to sinus rhythm.
Some [[physical examination]] findings of [[atrial fibrillation]] include [[irregularly irregular pulse]], possible high [[blood pressure]], and other [[Medical sign|sign]] of [[congestive heart failure]]. The [[Hemodynamics|hemodynamic stability]] of the [[patient]] should be first assessed. The [[patient]] should also be examined for the presence of reversible causes of [[atrial fibrillation]]. A study of routine [[pulse]] checks during routine office visits, found that the annual rate of [[atrial fibrillation]] [[diagnosis]] in [[old age|elderly]] [[patients]] altered from 1.04% to 1.63%. This implies that routine [[physical examination|examination]] has 64% (1.04/1.63) [[sensitivity (tests)|sensitivity]] and should be done regularly. [[Thyroid]] [[physical examination|exmaination]] should be considered, specially in younger [[patients]] with [[atrial fibrillation]]. In [[patients]] with [[dyspnea]], [[tachypnea]] could be detected and a finding such as [[rales]] would suggest [[heart failure]].


Detailed history and physical examination are essential to define;
==Physical Examination==
* The presence and nature of symptoms associated with AF
===Appearance of the Patient===
* The clinical type of AF (first episode, paroxysmal, persistent, or permanent)
*[[Patients]] with [[atrial fibrillation]] usually appear normal.
* The onset of the first symptomatic attack or date of discovery of AF
===Vital Signs===
* The frequency, duration, precipitating factors, and modes of termination of AF
The following are some common [[vital sign]] findings in [[patients]] with [[atrial fibrillation]] ([[AF]]):<ref name="pmid34020968">{{cite journal| author=Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee| title=Atrial fibrillation: diagnosis and management-summary of NICE guidance. | journal=BMJ | year= 2021 | volume= 373 | issue=  | pages= n1150 | pmid=34020968 | doi=10.1136/bmj.n1150 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34020968  }} </ref><ref name="pmid17673732">{{cite journal |author=Fitzmaurice DA, Hobbs FD, Jowett S, ''et al'' |title=Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial |journal= |volume= |issue= |pages= |year=2007 |pmid=17673732 |doi=10.1136/bmj.39280.660567.55}}</ref><ref name="pmid9196408">{{cite journal| author=Heppell RM, Berkin KE, McLenachan JM, Davies JA| title=Haemostatic and haemodynamic abnormalities associated with left atrial thrombosis in non-rheumatic atrial fibrillation. | journal=Heart | year= 1997 | volume= 77 | issue= 5 | pages= 407-11 | pmid=9196408 | doi=10.1136/hrt.77.5.407 | pmc=484760 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9196408  }} </ref>
* The response to any pharmacological agents that have been administered
*[[Pulse]]:
* The presence of any underlying heart disease or other reversible conditions (e.g., hyperthyroidism or alcohol consumption)
**In the setting of [[drug]] [[toxicity]] or [[hypothermia]], the [[pulse]] may be slower.
**The [[pulse]] is [[Irregularly irregular pulse|irregularly irregular]]. In general the [[heart rate]] is 100-140 beats per minute.
**In the presence of [[atrial fibrillation]] the [[pulse]] could be 150-170 beats per minute (rare).
*[[Blood pressure]]:
**The [[blood pressure]] should be checked as [[hypertension]] is one of the leading causes of [[atrial fibrillation]]. 
**Narrow [[pulse pressure]] (when [[Blood pressure|systolic blood pressure]] minus [[Blood pressure|diastolic blood pressure]] is < 25 mm Hg) usually suggest [[congestive heart failure]].
*[[Respiratory rate]]:
**In [[patients]] with [[dyspnea]], [[tachypnea]] could be detected.
 
===Skin===
*[[Skin]] [[physical examination|examination]] of [[patients]] with [[atrial fibrillation]] is usually normal.
 
===HEENT===
*[[Exopthalmos]] may suggest [[hyperthyroidism]].<ref name="pmid17673732">{{cite journal |author=Fitzmaurice DA, Hobbs FD, Jowett S, ''et al'' |title=Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial |journal= |volume= |issue= |pages= |year=2007 |pmid=17673732 |doi=10.1136/bmj.39280.660567.55}}</ref>
* [[retina|Retinal]] [[bleeding|hemorrhage]] may be seen in [[malignant hypertension]]
 
===Neck===
* The [[patient]] should be examined for the presence of [[thyroid]] abnormalities.
* [[Jugular venous distension]] could be seen in concurrent [[hypertension]] or [[heart failure]].
===Lung===
* [[Rales]] would suggest [[heart failure]].
===Heart===
*The [[patient]] should be examined to assess for the presence of [[congestive heart failure]] or [[hypertrophic obstructive cardiomyopathy]].
*[[S3]] and [[S4]] would suggest [[heart failure]].
*[[Heart murmurs]] and their intensity during postural changes can identify different [[valvular heart diseases]].
===Abdomen===
* [[abdomen|Abdominal]] [[physical examination|examination]] of [[patients]] with [[atrial fibrillation]] is usually normal.
===Back===
* [[Human back|Back]] [[physical examination|examination]] of [[patients]] with [[atrial fibrillation]] is usually normal.
===Genitourinary===
* Genitourinary [[physical examination|examination]] of [[patients]] with [[atrial fibrillation]] is usually normal.
===Neuromuscular===
* [[Neuromuscular]] [[physical examination|examination]] of [[patients]] with [[atrial fibrillation]] is usually normal.
===Extremities===
* [[Human leg|Lower leg]] [[edema]] may suggest [[Congestive heart failure|cardiac failure]].


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{Electrocardiography}}
{{Circulatory system pathology}}


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Latest revision as of 06:36, 21 October 2021
Resident
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]

Overview

Some physical examination findings of atrial fibrillation include irregularly irregular pulse, possible high blood pressure, and other sign of congestive heart failure. The hemodynamic stability of the patient should be first assessed. The patient should also be examined for the presence of reversible causes of atrial fibrillation. A study of routine pulse checks during routine office visits, found that the annual rate of atrial fibrillation diagnosis in elderly patients altered from 1.04% to 1.63%. This implies that routine examination has 64% (1.04/1.63) sensitivity and should be done regularly. Thyroid exmaination should be considered, specially in younger patients with atrial fibrillation. In patients with dyspnea, tachypnea could be detected and a finding such as rales would suggest heart failure.

Physical Examination

Appearance of the Patient

Vital Signs

The following are some common vital sign findings in patients with atrial fibrillation (AF):[1][2][3]

Skin

HEENT

Neck

Lung

Heart

Abdomen

Back

Genitourinary

Neuromuscular

Extremities

References

  1. ↑ Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee (2021). "Atrial fibrillation: diagnosis and management-summary of NICE guidance". BMJ. 373: n1150. doi:10.1136/bmj.n1150. PMID 34020968 Check |pmid= value (help).
  2. ↑ 2.0 2.1 Fitzmaurice DA, Hobbs FD, Jowett S; et al. (2007). "Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial". doi:10.1136/bmj.39280.660567.55. PMID 17673732.
  3. ↑ Heppell RM, Berkin KE, McLenachan JM, Davies JA (1997). "Haemostatic and haemodynamic abnormalities associated with left atrial thrombosis in non-rheumatic atrial fibrillation". Heart. 77 (5): 407–11. doi:10.1136/hrt.77.5.407. PMC 484760. PMID 9196408.


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