Atrial fibrillation etiology and differential diagnosis: Difference between revisions

Jump to navigation Jump to search
(New page: {| border="1" style="border-collapse:collapse" cellpadding="3" align="right" | colspan="3" align="center" bgcolor="#ABCDEF" | Conduction |- | <small>Sinus rhythm</small> [[Image:Heart cond...)
 
m (Bot: Adding CME Category::Cardiology)
 
(5 intermediate revisions by 3 users not shown)
Line 20: Line 20:
}}
}}
{{SI}}
{{SI}}
{{WikiDoc Cardiology Network Infobox}}
 
{{CMG}}
{{CMG}}


'''Associate Editor-In-Chief:''' {{CZ}}
'''Associate Editor-In-Chief:''' {{CZ}}


{{Editor Join}}
 


'''Synonyms and related keywords''': AF, Afib, fib
'''Synonyms and related keywords''': AF, Afib, fib
Line 39: Line 39:


===Complete Differential Diagnosis of Underlying Etiologies for Atrial Fibrillation===
===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 [[Transient ischemic attack|TIA]], as well as [[hypertension]] (high blood pressure), [[diabetes mellitus|diabetes]], [[heart failure]] and [[rheumatic fever]], may indicate whether someone with [[atrial fibrillation]] is at a higher risk of complications.<ref name="pmid16908781">{{cite journal |author=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 |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]] |volume=114 |issue=7 |pages=e257–354 |year=2006 |month=August |pmid=16908781 |doi=10.1161/CIRCULATIONAHA.106.177292 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=16908781 |issn=}}</ref>
{|style="width:70%; height:100px" border="1"
{|style="width:70%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
Line 132: Line 134:
|}
|}


==The autonomic nervous system may trigger [[AF]] in susceptible patients through heightened vagal or adrenergic tone==
==See Also==
 
* [[The Living Guidelines: Diagnosis and Management of Atrial Fibrillation | The AF Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
===Morphology===
The primary pathologic change seen in atrial fibrillation is the progressive fibrosis of the atria.  This fibrosis is primarily due to atrial dilatation, however genetic causes and inflammation may have a cause in some individuals.
 
Dilatation of the atria can be due to almost any structural abnormality of the heart that can cause a rise in the intra-cardiac pressures.  This includes valvular heart disease (such as mitral stenosis, mitral regurgitation, and tricuspid regurgitation), hypertension, and congestive heart failure.  Any inflammatory state that affects the heart can cause fibrosis of the atria.  This is typically due to sarcoidosis but may also be due to autoimmune disorders that create autoantibodies against myosin heavy chains.  Mutation of the ''[[lamin]] AC'' gene is also associated with fibrosis of the atria that can lead to atrial fibrillation.
 
Once dilatation of the atria has occurred, this begins a chain of events that leads to the activation of the [[renin-angiotensin system|renin aldosterone angiotensin system]] (RAAS) and subsequent increase in matrix metaloproteinases and disintegrin, which leads to atrial remodeling and fibrosis, with loss of atrial muscle mass.
 
This process is not immediate, and experimental studies have revealed patchy atrial fibrosis may precede the occurrence of atrial fibrillation and may progress with prolonged durations of atrial fibrillation.
 
Fibrosis is not limited to the muscle mass of the atria, and may occur in the [[sinus node]] (SA node) and [[atrioventricular node]] (AV node), correlating with [[sick sinus syndrome]].  Prolonged episodes of atrial fibrillation have been shown to correlate with prolongation of the sinus node recovery time,<ref name="pmid16908781"/> <ref name="pmid8941126">{{cite journal |author=Elvan A, Wylie K, Zipes D |title=Pacing-induced chronic atrial fibrillation impairs sinus node function in dogs. Electrophysiological remodeling |journal=Circulation |volume=94 |issue=11 |pages=2953–60 |year=1996 |url=http://www.circ.ahajournals.org/cgi/content/abstract/94/11/2953 |pmid=8941126 }}</ref><ref name="pmid11469431">{{cite journal |author=Manios EG, Kanoupakis EM, Mavrakis HE, Kallergis EM, Dermitzaki DN, Vardas PE |title=Sinus pacemaker function after cardioversion of chronic atrial fibrillation: is sinus node remodeling related with recurrence? |journal=Journal of Cardiovascular Electrophysiology |volume=12 |issue=7 |pages=800–6 |year=2001 |pmid=11469431 |doi=10.1046/j.1540-8167.2001.00800.x }}</ref> suggesting that dysfunction of the SA node is progressive with prolonged episodes of atrial fibrillation.
 
==Signs and symptoms==
 
In general, clinical manifestations are;
# [[Palpitations]]
# [[Chest pain]]
# [[Dyspnea]]
# [[Fatigue]]
# [[Lightheadedness]]
# Syncope: [[Syncope]] is an uncommon but serious complication that is usually associated with [[sinus node]] dysfunction or hemodynamic obstruction, such as valvular [[aortic stenosis]], [[HCM]], [[cerebrovascular disease]], or an accessory AV pathway.
 
[[Atrial fibrillation]] is usually accompanied by symptoms related to the rapid heart rate. Rapid and irregular heart rates may be perceived as [[palpitations]], [[exercise intolerance]], and occasionally produce [[Angina pectoris|angina]] (if the rate is faster and puts the heart under strain) and [[heart failure|congestive]] symptoms of [[shortness of breath]] or [[edema]]. Sometimes the [[arrhythmia]] will be identified only with the onset of a stroke or a [[transient ischemic attack]] ([[TIA]], [[stroke]] symptoms resolving within 24 hours). It is not uncommon to identify [[atrial fibrillation]] on a routine physical examination or [[electrocardiogram]] (ECG/EKG), as it may be asymptomatic in many cases.<ref name="pmid16908781"/>
 
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 [[Transient ischemic attack|TIA]], as well as [[hypertension]] (high blood pressure), [[diabetes mellitus|diabetes]], [[heart failure]] and [[rheumatic fever]], may indicate whether someone with [[atrial fibrillation]] is at a higher risk of complications.<ref name="pmid16908781"/>


==References==
==References==
Line 166: Line 144:
* 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.
* 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
* 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
* Braunwald's Heart Disease, Libby P, 8th ed., 2007, ISBN 978-1-41-604105-4
* Hurst's the Heart, Fuster V, 12th ed. 2008, ISBN 978-0-07-149928-6
* Willerson JT, Cardiovascular Medicine, 3rd ed., 2007, ISBN 978-1-84628-188-4
{{refend}}
{{refend}}


{{Electrocardiography}}
{{Electrocardiography}}
{{Circulatory system pathology}}
{{Circulatory system pathology}}
{{SIB}}


[[Category:Electrophysiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]


[[de:Vorhofflimmern]]
[[de:Vorhofflimmern]]
Line 193: Line 164:
{{WikiDoc Help Menu}}
{{WikiDoc Help Menu}}
{{WikiDoc Sources}}
{{WikiDoc Sources}}
[[CME Category::Cardiology]]
[[Category:Electrophysiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]

Latest revision as of 01:04, 15 March 2016

Conduction
Sinus rhythm
Atrial fibrillation
Atrial fibrillation
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

WikiDoc Resources for Atrial fibrillation etiology and differential diagnosis

Articles

Most recent articles on Atrial fibrillation etiology and differential diagnosis

Most cited articles on Atrial fibrillation etiology and differential diagnosis

Review articles on Atrial fibrillation etiology and differential diagnosis

Articles on Atrial fibrillation etiology and differential diagnosis in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Atrial fibrillation etiology and differential diagnosis

Images of Atrial fibrillation etiology and differential diagnosis

Photos of Atrial fibrillation etiology and differential diagnosis

Podcasts & MP3s on Atrial fibrillation etiology and differential diagnosis

Videos on Atrial fibrillation etiology and differential diagnosis

Evidence Based Medicine

Cochrane Collaboration on Atrial fibrillation etiology and differential diagnosis

Bandolier on Atrial fibrillation etiology and differential diagnosis

TRIP on Atrial fibrillation etiology and differential diagnosis

Clinical Trials

Ongoing Trials on Atrial fibrillation etiology and differential diagnosis at Clinical Trials.gov

Trial results on Atrial fibrillation etiology and differential diagnosis

Clinical Trials on Atrial fibrillation etiology and differential diagnosis at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Atrial fibrillation etiology and differential diagnosis

NICE Guidance on Atrial fibrillation etiology and differential diagnosis

NHS PRODIGY Guidance

FDA on Atrial fibrillation etiology and differential diagnosis

CDC on Atrial fibrillation etiology and differential diagnosis

Books

Books on Atrial fibrillation etiology and differential diagnosis

News

Atrial fibrillation etiology and differential diagnosis in the news

Be alerted to news on Atrial fibrillation etiology and differential diagnosis

News trends on Atrial fibrillation etiology and differential diagnosis

Commentary

Blogs on Atrial fibrillation etiology and differential diagnosis

Definitions

Definitions of Atrial fibrillation etiology and differential diagnosis

Patient Resources / Community

Patient resources on Atrial fibrillation etiology and differential diagnosis

Discussion groups on Atrial fibrillation etiology and differential diagnosis

Patient Handouts on Atrial fibrillation etiology and differential diagnosis

Directions to Hospitals Treating Atrial fibrillation etiology and differential diagnosis

Risk calculators and risk factors for Atrial fibrillation etiology and differential diagnosis

Healthcare Provider Resources

Symptoms of Atrial fibrillation etiology and differential diagnosis

Causes & Risk Factors for Atrial fibrillation etiology and differential diagnosis

Diagnostic studies for Atrial fibrillation etiology and differential diagnosis

Treatment of Atrial fibrillation etiology and differential diagnosis

Continuing Medical Education (CME)

CME Programs on Atrial fibrillation etiology and differential diagnosis

International

Atrial fibrillation etiology and differential diagnosis en Espanol

Atrial fibrillation etiology and differential diagnosis en Francais

Business

Atrial fibrillation etiology and differential diagnosis in the Marketplace

Patents on Atrial fibrillation etiology and differential diagnosis

Experimental / Informatics

List of terms related to Atrial fibrillation etiology and differential diagnosis

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 (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. Unknown parameter |month= ignored (help)
  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


de:Vorhofflimmern it:Fibrillazione atriale nl:Boezemfibrilleren no:Atrieflimmer fi:Eteisvärinä


Template:WikiDoc Sources CME Category::Cardiology