Atrial fibrillation etiology and differential diagnosis
| 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 |
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 |
See Also
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.
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
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