Atrial fibrillation physical examination: Difference between revisions
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==Physical Examination== | ==Physical Examination== | ||
===Appearance of the Patient=== | |||
*[[Patients]] with [[atrial fibrillation]] usually appear normal. | |||
===Vital Signs=== | ===Vital Signs=== | ||
The following are some common vital sign findings in [[patients]] with [[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> | 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> | ||
*[[Pulse]]: | *[[Pulse]]: | ||
**In the setting of [[drug]] [[toxicity]] or [[hypothermia]], the [[pulse]] may be slower. | **In the setting of [[drug]] [[toxicity]] or [[hypothermia]], the [[pulse]] may be slower. | ||
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**The [[blood pressure]] should be checked as [[hypertension]] is one of the leading causes of [[atrial fibrillation]]. | **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]]. | **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> | *[[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> | ||
* Retinal hemorrhage may be seen in [[malignant hypertension]] | * [[retina|Retinal]] [[bleeding|hemorrhage]] may be seen in [[malignant hypertension]] | ||
===Neck=== | ===Neck=== | ||
* The patient should be examined for the presence of thyroid abnormalities. | * 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=== | ===Heart=== | ||
*The patient should be examined to assess for the presence of [[congestive heart failure]] or [[hypertrophic obstructive cardiomyopathy]]. | *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]]. | *[[S3]] and [[S4]] would suggest [[heart failure]]. | ||
*Heart murmurs | *[[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=== | ||
* Lower leg [[edema]] may suggest cardiac failure. | * 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== | ||
Revision as of 07:13, 7 October 2021
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Atrial fibrillation  |
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Atrial fibrillation physical examination On the Web | |
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Directions to Hospitals Treating Atrial fibrillation physical examination | |
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Risk calculators and risk factors for Atrial fibrillation physical examination | |
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.
Physical Examination
Appearance of the Patient
- Patients with atrial fibrillation usually appear normal.
Vital Signs
The following are some common vital sign findings in patients with atrial fibrillation (AF):[1][2]
- Pulse:
- In the setting of drug toxicity or hypothermia, the pulse may be slower.
- The pulse is 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 systolic blood pressure minus diastolic blood pressure is < 25 mm Hg) usually suggest congestive heart failure.
- Respiratory rate:
Skin
- Skin examination of patients with atrial fibrillation is usually normal.
HEENT
- Exopthalmos may suggest hyperthyroidism.[2]
- Retinal 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
- Abdominal examination of patients with atrial fibrillation is usually normal.
Back
- Back examination of patients with atrial fibrillation is usually normal.
Genitourinary
- Genitourinary examination of patients with atrial fibrillation is usually normal.
Neuromuscular
- Neuromuscular examination of patients with atrial fibrillation is usually normal.
Extremities
- Lower leg edema may suggest cardiac failure.
References
- ↑ 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). - ↑ 2.0 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.