Atrial fibrillation differential diagnosis: Difference between revisions
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* 2% of people younger than age 65 have AFib, while about 9% of people aged 65 years or older have AFib | * 2% of people younger than age 65 have AFib, while about 9% of people aged 65 years or older have AFib | ||
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* | * Elderly | ||
* Following bypass surgery | * Following bypass surgery | ||
* Mitral valve disease | * Mitral valve disease | ||
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* Regular or Irregular | * Regular or Irregular | ||
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* 75 (4:1 block), 100 (3:1 block) and 150 (2:1 block) bpm, but 150 is more common | * 75 (4:1 block), 100 (3:1 block) and 150 (2:1 block) beats per minute (bpm), but 150 is more common | ||
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* Sawtooth pattern of P waves at 250 to 350 | * Sawtooth pattern of P waves at 250 to 350 bpm | ||
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* Varies depending upon the magnitude of the block, but is short | * Varies depending upon the magnitude of the block, but is short | ||
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* Incidence: 88 per 100,000 individuals | * Incidence: 88 per 100,000 individuals | ||
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* | * Elderly | ||
*Alcohol | *Alcohol | ||
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* 0.05% to 0.32% of electrocardiograms in general hospital admissions | * 0.05% to 0.32% of electrocardiograms in general hospital admissions | ||
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* | * Elderly | ||
*COPD | |||
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|'''Paroxysmal Supraventricular Tachycardia''' | |'''Paroxysmal Supraventricular Tachycardia''' | ||
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* Regular | * Regular | ||
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* 150 and 240 | * 150 and 240 bpm | ||
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* Absent | * Absent | ||
* Hidden in QRS | * Hidden in QRS | ||
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* Absent | |||
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* Narrow complexes (< 0.12 s) | * Narrow complexes (< 0.12 s) | ||
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* Wolff-Parkinson-White syndrome | * Wolff-Parkinson-White syndrome | ||
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|'''Premature Atrial Contractrions (PAC)''' | |'''Premature Atrial Contractrions (PAC)'''<ref name="pmid26316525">{{cite journal |vauthors=Lin CY, Lin YJ, Chen YY, Chang SL, Lo LW, Chao TF, Chung FP, Hu YF, Chong E, Cheng HM, Tuan TC, Liao JN, Chiou CW, Huang JL, Chen SA |title=Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long-Term Outcome |journal=J Am Heart Assoc |volume=4 |issue=9 |pages=e002192 |date=August 2015 |pmid=26316525 |pmc=4599506 |doi=10.1161/JAHA.115.002192 |url=}}</ref> | ||
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* Regular except when disturbed by premature beat(s) | * Regular except when disturbed by premature beat(s) | ||
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* 80-120 bpm | |||
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* Upright | * Upright | ||
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* > 0.12 second | * > 0.12 second | ||
* May be shorter than that in normal sinus rhythm (NSR) if the origin of PAC is located closer to the AV node | * May be shorter than that in normal sinus rhythm (NSR) if the origin of PAC is located closer to the AV node | ||
*Ashman’s Phenomenon: | |||
**PAC displaying a right bundle branch block pattern | |||
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* Usually narrow (< 0.12 s) | * Usually narrow (< 0.12 s) | ||
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* Coronary artery disease | * Coronary artery disease | ||
* Stroke | * Stroke | ||
*Increased atrial natruiretic peptide (ANP) | |||
*Hypercholesterolemia | |||
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|'''Wolff-Parkinson-White Syndrome<ref name="pmid24982705">{{cite journal |vauthors=Rao AL, Salerno JC, Asif IM, Drezner JA |title=Evaluation and management of wolff-Parkinson-white in athletes |journal=Sports Health |volume=6 |issue=4 |pages=326–32 |date=July 2014 |pmid=24982705 |pmc=4065555 |doi=10.1177/1941738113509059 |url=}}</ref><ref name="pmid10597097">{{cite journal |vauthors=Rosner MH, Brady WJ, Kefer MP, Martin ML |title=Electrocardiography in the patient with the Wolff-Parkinson-White syndrome: diagnostic and initial therapeutic issues |journal=Am J Emerg Med |volume=17 |issue=7 |pages=705–14 |date=November 1999 |pmid=10597097 |doi=10.1016/s0735-6757(99)90167-5 |url=}}</ref>''' | |'''Wolff-Parkinson-White Syndrome<ref name="pmid24982705">{{cite journal |vauthors=Rao AL, Salerno JC, Asif IM, Drezner JA |title=Evaluation and management of wolff-Parkinson-white in athletes |journal=Sports Health |volume=6 |issue=4 |pages=326–32 |date=July 2014 |pmid=24982705 |pmc=4065555 |doi=10.1177/1941738113509059 |url=}}</ref><ref name="pmid10597097">{{cite journal |vauthors=Rosner MH, Brady WJ, Kefer MP, Martin ML |title=Electrocardiography in the patient with the Wolff-Parkinson-White syndrome: diagnostic and initial therapeutic issues |journal=Am J Emerg Med |volume=17 |issue=7 |pages=705–14 |date=November 1999 |pmid=10597097 |doi=10.1016/s0735-6757(99)90167-5 |url=}}</ref>''' | ||
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* Tuberous sclerosis | * Tuberous sclerosis | ||
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|'''Ventricular Fibrillation''' | |'''Ventricular Fibrillation'''<ref name="pmid27899944">{{cite journal |vauthors=Glinge C, Sattler S, Jabbari R, Tfelt-Hansen J |title=Epidemiology and genetics of ventricular fibrillation during acute myocardial infarction |journal=J Geriatr Cardiol |volume=13 |issue=9 |pages=789–797 |date=September 2016 |pmid=27899944 |pmc=5122505 |doi=10.11909/j.issn.1671-5411.2016.09.006 |url=}}</ref> | ||
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* Irregular | * Irregular | ||
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* Absent (R on T phenomenon in the setting of ischemia) | * Absent (R on T phenomenon in the setting of ischemia) | ||
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* Does not break in response to procainamide, adenosine, vagal maneuvers | |||
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Revision as of 05:00, 16 December 2019
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Atrial fibrillation differential diagnosis On the Web | |
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Risk calculators and risk factors for Atrial fibrillation differential diagnosis | |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Atrial fibrillation must be distinguished from other common atrial arrhythmias, which include atrial flutter, atrial tachycardia, paroxysmal supraventricular tachycardia, Wolff-Parkinson-White syndrome, and atrioventricular nodal reentry tachycardia.
Differentiating Atrial Fibrillation from other Diseases
Atrial fibrillation has to be differnetiated from other diseases like:
- Atrial flutter
- Atrial tachycardia
- Atrioventricular nodal reentry tachycardia (AVNRT)
- Multifocal atrial tachycardia
- Paroxysmal supraventricular tachycardia
- Wolff-Parkinson-White syndrome
The differentiating features are largely based on both EKG findings and cardiovascular examination.
- Atrial fibrillation is irregularly irregular, while the other rhythms such as atrial flutter, sinus tachycardia, AV nodal reentry tachycardia and paroxysmal supraventricular tachycardia are all much more regular.
- An atrioventricular nodal reentry tachycardia will often break with either carotid sinus massage or AV nodal blocking agents.
- If the patient has Wolff-Parkinson-White syndrome there may be much more rapid conduction. The presence of the delta wave on EKG is characteristic.
Arrhythmia | Rhythm | Rate | P wave | PR Interval | QRS Complex | Response to Maneuvers | Epidemiology | Co-existing Conditions |
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Atrial Fibrillation[1][2] |
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Atrial Flutter |
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Atrioventricular nodal reentry tachycardia (AVNRT)[3][4][5][6] |
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Multifocal Atrial Tachycardia[7][8] |
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Paroxysmal Supraventricular Tachycardia |
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Premature Atrial Contractrions (PAC)[9] |
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Wolff-Parkinson-White Syndrome[10][11] |
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Ventricular Fibrillation[12] |
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Ventricular Tacycardia |
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References
- ↑ Lankveld TA, Zeemering S, Crijns HJ, Schotten U (July 2014). "The ECG as a tool to determine atrial fibrillation complexity". Heart. 100 (14): 1077–84. doi:10.1136/heartjnl-2013-305149. PMID 24837984.
- ↑ Harris K, Edwards D, Mant J (2012). "How can we best detect atrial fibrillation?". J R Coll Physicians Edinb. 42 Suppl 18: 5–22. doi:10.4997/JRCPE.2012.S02. PMID 22518390.
- ↑ Katritsis DG, Josephson ME (August 2016). "Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia". Arrhythm Electrophysiol Rev. 5 (2): 130–5. doi:10.15420/AER.2016.18.2. PMC 5013176. PMID 27617092.
- ↑ Letsas KP, Weber R, Siklody CH, Mihas CC, Stockinger J, Blum T, Kalusche D, Arentz T (April 2010). "Electrocardiographic differentiation of common type atrioventricular nodal reentrant tachycardia from atrioventricular reciprocating tachycardia via a concealed accessory pathway". Acta Cardiol. 65 (2): 171–6. doi:10.2143/AC.65.2.2047050. PMID 20458824.
- ↑ "Atrioventricular Nodal Reentry Tachycardia (AVNRT) - StatPearls - NCBI Bookshelf".
- ↑ Schernthaner C, Danmayr F, Strohmer B (2014). "Coexistence of atrioventricular nodal reentrant tachycardia with other forms of arrhythmias". Med Princ Pract. 23 (6): 543–50. doi:10.1159/000365418. PMC 5586929. PMID 25196716.
- ↑ Scher DL, Arsura EL (September 1989). "Multifocal atrial tachycardia: mechanisms, clinical correlates, and treatment". Am. Heart J. 118 (3): 574–80. doi:10.1016/0002-8703(89)90275-5. PMID 2570520.
- ↑ Goodacre S, Irons R (March 2002). "ABC of clinical electrocardiography: Atrial arrhythmias". BMJ. 324 (7337): 594–7. doi:10.1136/bmj.324.7337.594. PMC 1122515. PMID 11884328.
- ↑ Lin CY, Lin YJ, Chen YY, Chang SL, Lo LW, Chao TF, Chung FP, Hu YF, Chong E, Cheng HM, Tuan TC, Liao JN, Chiou CW, Huang JL, Chen SA (August 2015). "Prognostic Significance of Premature Atrial Complexes Burden in Prediction of Long-Term Outcome". J Am Heart Assoc. 4 (9): e002192. doi:10.1161/JAHA.115.002192. PMC 4599506. PMID 26316525.
- ↑ Rao AL, Salerno JC, Asif IM, Drezner JA (July 2014). "Evaluation and management of wolff-Parkinson-white in athletes". Sports Health. 6 (4): 326–32. doi:10.1177/1941738113509059. PMC 4065555. PMID 24982705.
- ↑ Rosner MH, Brady WJ, Kefer MP, Martin ML (November 1999). "Electrocardiography in the patient with the Wolff-Parkinson-White syndrome: diagnostic and initial therapeutic issues". Am J Emerg Med. 17 (7): 705–14. doi:10.1016/s0735-6757(99)90167-5. PMID 10597097.
- ↑ Glinge C, Sattler S, Jabbari R, Tfelt-Hansen J (September 2016). "Epidemiology and genetics of ventricular fibrillation during acute myocardial infarction". J Geriatr Cardiol. 13 (9): 789–797. doi:10.11909/j.issn.1671-5411.2016.09.006. PMC 5122505. PMID 27899944.