Atrial fibrillation history and symptoms
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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:
- 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 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.
- The clinical type of atrial fibrillation (AF) (first episode, paroxysmal, persistent, or permanent).
- The onset of the first symptomatic attack or date of discovery of atrial fibrillation (AF).
- The frequency, duration, precipitating factors, and modes of termination (e.g vagal maeuvers) of atrial fibrillation (AF).
- The response to any 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 consumption).
Symptoms
- Common symptoms of atrial fibrillation include:[1][2][3][4]
- Palpitations
- Palpitation has been presented in 42%–55% of patients with atrial fibrillation.
- Palpitation is the prominent symptom in paroxysmal type of atrial fibrillation.
- Exercise intolerance due to the rapid heart rate
- Fatigue
- Lightheadedness and dizziness
- Asthenia
- Palpitations
- More serious symptoms include the following:[4]
- Chest pain if there is underlying atherosclerosis.
- Dyspnea, shortness of breath and edema if congestive heart failure is present.
- Syncope: Syncope is an uncommon but serious complication that is usually associated with sinus node dysfunction or hemodynamic obstruction, such as valvular aortic stenosis, hypertrophic cardiomyopathy, cerebrovascular disease, or an 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 asymptomatic, which is called silent atrial fibrillation.[2][5]
- There are studies that suggest 1 patient out of 5 atrial fibrillation patients might be asymptomatic. [6][7]
- Symptoms such as asthenia, dyspnea and fatigue have been observed frequently in permanent AF.[8]
References
- ↑ 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.
- ↑ 2.0 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.
- ↑ 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.
- ↑ 4.0 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.