Atrial fibrillation history and symptoms: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
 
(9 intermediate revisions by 2 users not shown)
Line 10: Line 10:


==Overview==
==Overview==
Approximately 90% of episodes of atrial fibrillation are asymptomatic. Indeed, it is not uncommon to identify atrial fibrillation on a routine physical examination <BR> or [[electrocardiogram|electrocardiogram (ECG)]], as it may be asymptomatic in many cases.<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>  The section below describes the constellation of symptoms (usually [[palpitations]] and [[exercise intolerance]]) when they do occur.
[[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 [[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 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 the time at which an episode of [[atrial fibrillation]] begins and when they revert to [[normal sinus rhythm]] could be determined.
:#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 [[AF]] (first episode, paroxysmal, persistent, or permanent).
* The clinical type of [[atrial fibrillation]] ([[AF]]) (first episode, paroxysmal, persistent, or permanent).
* The onset of the first [[symptom|symptomatic attack]] or date of discovery of [[AF]].
* The onset of the first [[symptom|symptomatic attack]] or date of discovery of [[atrial fibrillation]] ([[AF]]).
* The frequency, duration, precipitating factors, and modes of termination (e.g [[vagal maeuvers]]) of [[AF]].
* The frequency, duration, precipitating factors, and modes of termination (e.g [[vagal maeuvers]]) of [[atrial fibrillation]] ([[AF]]).
* The response to any [[Pharmacology|pharmacological agents]] that have been administered or history of ablation.
* The response to any [[Pharmacology|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|alcohol consumption]]).


==Symptoms==
==Symptoms==
When [[symptoms]] are present, they often include [[symptoms]] related to the rapid [[heart rate]]:
*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]] and [[dizziness]]
**[[Exercise intolerance]] due to the [[rapid heart rate]]
 
**[[Fatigue]]
 
**[[Lightheadedness]] and [[dizziness]]
More serious [[symptoms]] include the following:
**[[Asthenia]]
* [[Chest pain]] if there is underlying [[atherosclerosis]].
*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>
* [[Dyspnea]], [[Dyspnea|shortness of breath]] and [[edema]] if [[congestive heart failure]] is present.
**[[Chest pain]] if there is underlying [[atherosclerosis]].
* [[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]].
**[[Dyspnea]], [[Dyspnea|shortness of breath]] and [[edema]] if [[congestive heart failure]] is present.
* [[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.
**[[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==

Latest revision as of 04:55, 3 March 2024



Resident
Survival
Guide

Atrial Fibrillation Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Atrial Fibrillation from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Special Groups

Postoperative AF
Acute Myocardial Infarction
Wolff-Parkinson-White Preexcitation Syndrome
Hypertrophic Cardiomyopathy
Hyperthyroidism
Pulmonary Diseases
Pregnancy
ACS and/or PCI or valve intervention
Heart failure

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples
A-Fib with LBBB

Chest X Ray

Echocardiography

Holter Monitoring and Exercise Stress Testing

Cardiac MRI

Treatment

Rate and Rhythm Control

Cardioversion

Overview
Electrical Cardioversion
Pharmacological Cardioversion

Anticoagulation

Overview
Warfarin
Converting from or to Warfarin
Converting from or to Parenteral Anticoagulants
Dabigatran

Maintenance of Sinus Rhythm

Surgery

Catheter Ablation
AV Nodal Ablation
Surgical Ablation
Cardiac Surgery

Specific Patient Groups

Primary Prevention

Secondary Prevention

Supportive Trial Data

Cost-Effectiveness of Therapy

Case Studies

Case #1

Atrial fibrillation history and symptoms On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Atrial fibrillation history and symptoms

CDC on Atrial fibrillation history and symptoms

Atrial fibrillation history and symptoms in the news

Blogs on Atrial fibrillation history and symptoms

Directions to Hospitals Treating Atrial fibrillation history and symptoms

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:

  1. 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).
  2. 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.

Symptoms

References

  1. 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. 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.
  3. 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. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.

Template:WH Template:WS CME Category::Cardiology