Atrial fibrillation etiology and differential diagnosis: Difference between revisions

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	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

VisualWikitext

Latest revision as of 01:04, 15 March 2016

Conduction
Sinus rhythm	Atrial fibrillation

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 infarction • Congenital heart disease especially atrial septal defect in adults • Coronary artery disease • Heart failure (especially diastolic dysfunction and diastolic heart failure) • Hypertrophic cardiomyopathy (HCM) • Hypertension • Mitral regurgitation Mitral stenosis (e.g. due to Rheumatic heart disease or Mitral valve prolapse) • Myocarditis • Pericarditis • 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	Hyperthyroidism • Hypothyroidism • Pheochromocytoma
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 poisoning • Caffeine • 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 cancer • Pneumonia • Pulmonary embolism • Sarcoidosis • sleep apnea syndrome
Renal / Electrolyte	Hypokalemia
Rheum / Immune / Allergy	No underlying causes
Trauma	Electrocution • Cardiac contusion
Miscellaneous	Hypothermia • Fever

References

↑ 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)
↑ 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.
↑ 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.
↑ Saffitz JE (2006). "Connexins, conduction, and atrial fibrillation". N. Engl. J. Med. 354 (25): 2712–4. doi:10.1056/NEJMe068088. PMID 16790707.

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 ===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="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
@@ Line 131: / Line 133: @@
 |-
 |}
-==The autonomic nervous system may trigger [[AF]] in susceptible patients through heightened vagal or adrenergic tone==
-===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"/>
 ==See Also==
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 {{Electrocardiography}}
 {{Circulatory system pathology}}
-{{SIB}}
-[[Category:Electrophysiology]]
-[[Category:Cardiology]]
-[[Category:Emergency medicine]]
 [[de:Vorhofflimmern]]
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 {{WikiDoc Help Menu}}
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+[[CME Category::Cardiology]]
+[[Category:Electrophysiology]]
+[[Category:Cardiology]]
+[[Category:Emergency medicine]]

v t e Electrocardiography
Overview	History of the EKG • EKG interpretation basics • Normal sinus rhythm
EKG Complexes	P wave • QRS complex • ST Segment • T wave • T wave alternans • Tombstone T wave • U wave Osborn wave • H wave • K wave • Delta wave NSSTW changes
EKG Intervals	PR Interval • QRS Interval • ST Interval • QT Interval
Conduction System & Bradycardia	Cardiac pacemaker • SA node • AV node• Bundle of His • Purkinje fibers • Sinus bradycardia • First Degree AV Block • Second Degree AV Block • Complete or Third-Degree AV Block • Concealed conduction • AV Junctional Rhythms • LBBB • LAHB • LPHB • RBBB • Trifascicular block
Atrial Arrhythmias	Sinus tachycardia • Premature Atrial Contractions (PACs) • Ectopic Atrial Rhythm • Paroxysmal Atrial Tachycardia (PAT) • Paroxysmal Atrial Tachycardia (PAT) with Block • Multifocal Atrial Tachycardia (MAT) • Atrial Flutter • Atrial Fibrillation • Wandering atrial pacemaker
Ventricular Arrhythmias	Differential Diagnosis of Tachycardia with a Wide QRS Complex • Accelerated Idioventricular Rhythm • Ventricular Parasystole • Premature Ventricular Contractions (PVCs) • Ventricular tachycardia • Ventricular Fibrillation • Sudden cardiac death
EKG Abnormalities in Disease States	Hypertrophy & Dilatation • Right atrial enlargement • Left atrial enlargement • Biatrial enlargement • Left Ventricular Hypertrophy • Right Ventricular Hypertrophy • Biventricular Hypertrophy • Acute myocardial infarction • NSTEMI • STEMI • Tombstone ST elevation • Right ventricular myocardial infarction • Atrial infarction Pre-excitation Syndromes • Wolff-Parkinson-White Syndrome • Lown Ganong Levine Syndrome • Mahaim Type Preexcitation Cardiomyopathies • Arrhythmogenic Right Ventricular Dysplasia • Dilated Cardiomyopathy • Hypertrophic Cardiomyopathy Drug Effects on the EKG • Adenosine • β-blockers • Digitalis • Quinidine • Procainamide • Disopyramide • Lidocaine • Tocainide and Mexiletine • Phenytoin • Encainide, Flecainide and Propafenone • Amiodarone • Bretylium • Ca Channel Blockers • Phenothiazines • Tricyclic Antidepressants • Lithium Congenital Heart Disease • Dextrocardia • Atrial Septal Defect • Ventricular Septal Defect • Tetralogy of Fallot • Conjoined Twins or Siamese Twins • Congenital heart block Electrolyte Disturbances • Hyperkalemia • Hypokalemia • Hypercalcemia • Hypocalcemia • Nonspecific Changes Other Heart Diseases • Pericarditis • Myocarditis • Tamponade • Heart Transplantation • Sick Sinus Syndrome • Long QT Syndrome Inherited Disease • Brugada Syndrome Systemic Diseases • CNS Disease • Cardiac Tumors Heart Transplantation • EKG Changes in patient with Heart Transplantation Exogenous Effects • Hypothermia • Chest Trauma • Insect Bites • Electric Injuries
Technical Issues and Potential Errors in Interpretation	Artifacts • Lead Placement Errors • The EKG in a Patient with a Pacemaker • EKG in athletes

Atrial fibrillation etiology and differential diagnosis: Difference between revisions

Latest revision as of 01:04, 15 March 2016

Contents

Etiology of atrial fibrillation

Common Causes

Complete Differential Diagnosis of Underlying Etiologies for Atrial Fibrillation

See Also

References

Further Readings

Navigation menu


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