Question 1 of 10

    Atrial Fibrillation (AF)

    RapidAFib150 (cropped)[1]

    Atrial fibrillation is a clinical condition characterized by a rapid and irregularly regular atrial rhythm of the heart. This usually presents as palpitations, dyspnea, dizziness, fatigue, and weakness among afflicted patients. The irregular atrial rhythm in atrial fibrillation raises the risk for embolic stroke among susceptible patients.

    This disease emerges due to the following process: endocrine.

    Presentation

    Majority of patients will not present with any symptoms at all. Only mild palpitations, chest discomfort, light headedness, dyspnea, and generalized weakness are subjectively felt by the patients. Upon physical examinations, pulses and auscultatory findings will reveal an irregularly regular rhythm. Pulses may not coincide with ventricular rates because the pumping may not generate sufficient blood or force to produce peripheral pressure.

    cardiovascular
    Heart Failure
    • If the heartbeat is very fast for a long period of time, it can also lead to heart failure .[hrsonline.org]
    • AFib also sometimes causes heart failure.[massgeneral.org]
    • Signs of acute atrial fibrillation are: hypotension, myocardial ischemia, decreased perfusion of vital organs and acute congestive heart failure (CHF).[rnceus.com]
    • This irregular heart rhythm can lead to congestive heart failure and stroke.[inovaheart.org]
    Palpitations
    • Documentation of any previous surgical or percutaneous AF ablation procedures Palpitations Fatigue or poor exercise tolerance Presyncope or syncope Generalized weakness, dizziness, fatigue[emedicine.medscape.com]
    • (M3.CV.205) A 59-year-old woman presents to the ED with palpitations, which she has never experienced before now.[medbullets.com]
    • TOPIC Editors' Choice of Best Available Content This collection features the best content from AFP , as identified by the AFP editors, on atrial fibrillation and related issues, including anticoagulation therapy, antiplatelet therapy, arrhythmias, and palpitations[aafp.org]
    • Symptoms of atrial fibrillation include shortness of breath, heart palpitations, chest discomfort, dizziness and even fainting.[advocatehealth.com]
    • Medical Dictionary : very rapid uncoordinated contractions of the atria of the heart resulting in a lack of synchronism between heartbeat and pulse beat If you're experiencing chest pain, palpitations, lightheadedness or shortness of breath, you could[merriam-webster.com]
    Heart Disease
    • This usually only occurs in individuals who also have severe heart disease.[cedars-sinai.edu]
    • In fact, women are at a higher risk for heart disease in general, and AF is believed to be one effect of heart disease.[draxe.com]
    • Oftentimes, atrial fibrillation occurs in horses which have heart disease, typically advanced heart disease.[wagwalking.com]
    Chest Pain
    • Chest pain could signal that you're having a heart attack.[mayoclinic.org]
    • In many patients, it can also cause chest pain, heart attack , or heart failure .[medlineplus.gov]
    • Medical Dictionary : very rapid uncoordinated contractions of the atria of the heart resulting in a lack of synchronism between heartbeat and pulse beat If you're experiencing chest pain, palpitations, lightheadedness or shortness of breath, you could[merriam-webster.com]
    Hypertension
    • For atrial fibrillation, the major risk factors are increased age (over 50), obesity, family history, hypertension , diabetes and thyrotoxicosis (an excess of thyroid hormones).[hopkinsmedicine.org]
    • Some risk factors include COPD, pulmonary embolism, chest surgery, myocardial ischemia, cardiomyopathy, pericarditis, hypertension, atrial septal defects, mitral or aortic valve abnormalities, atrial myxoma, hyperthyroidism, alcohol, and sepsis.[medbullets.com]
    • Hypertension . 2007 Feb. 49 (2):311-6.[emedicine.medscape.com]
    • Beta blockers, ACE inhibitors, and angiotensin-receptor blockers (ARBs) appear to reduce the risk of AF in patients with hypertension.[health.harvard.edu]
    • Atrial fibrillation is more likely to occur in people with other conditions, such as high blood pressure (hypertension) , atherosclerosis , or a heart valve problem.[nhs.uk]
    Tachycardia
    • There are three major types of tachycardia: Atrial tachycardia (starting in the atria) Supraventricular tachycardia (starting above the ventricles) Ventricular tachycardia (starting in the ventricles) Bradycardia refers to a slow heart rhythm, caused[columbiasurgery.org]
    • Most people think of tachycardia as a supraventricular tachycardia, but there are many other forms of tachycardia.[uihc.org]
    • In addition, AF can be associated with hemodynamic dysfunction, tachycardia-induced cardiomyopathy, and systemic thromboembolism.[emedicine.medscape.com]
    • It's one of the supraventricular tachycardias.[khanacademy.org]
    • […] regular and irregular rhythms Recall the normal range for PR interval and QRS complex Recognize the features and qualifying criteria for the following complexes and rhythms: Premature Atrial Complexes Wandering Atrial Pacemaker Rhythm Multifocal Atrial Tachycardia[ekg.academy]
    Irregular Heart Rhythm
    • To determine the cause of your irregular heart rhythm, it is best to schedule a consultation with one of the electrophysiologists at California Pacific Medical Center (CPMC).[cpmc.org]
    • AF is the most common irregular heart rhythm, afflicting 2.2 million Americans.[bidmc.org]
    • However, women are more likely to feel their irregular heart rhythm and to have irregular heart beats.[uihc.org]
    • The result is a fast and irregular heart rhythm.[mayoclinic.org]
    • This irregular heart rhythm can lead to congestive heart failure and stroke.[inovaheart.org]
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  • gastrointestinal
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  • respiratoric
    Dyspnea
    • Although up to 90% of AF episodes may not cause symptoms, [47] many patients experience a wide variety of symptoms, including palpitations, dyspnea, fatigue, dizziness, angina, and decompensated heart failure.[emedicine.medscape.com]
    • Presentation can be asymptomatic, but common symptoms include dyspnea, palpitations, chest pain, or syncope.[medbullets.com]
    • More often, however, patients report nonspecific symptoms such as fatigue, dyspnea, dizziness, and diaphoresis.[clevelandclinicmeded.com]
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  • neurologic
    Stroke
    • There it might block blood flow, causing a stroke.[mayoclinic.org]
    • Stroke Prevention in Atrial Fibrillation.[en.wikipedia.org]
    • To help raise awareness about the association between AFib and the increased risk of stroke, National Stroke Association has developed the AFib-Stroke Connection .[stroke.org]
    • AF quintuples the risk of stroke.[health.harvard.edu]
    • This type of stroke is called an embolic stroke or some doctors call it a cardioembolic stroke.[strokeassociation.org]
    Dizziness
    • Documentation of any previous surgical or percutaneous AF ablation procedures Palpitations Fatigue or poor exercise tolerance Presyncope or syncope Generalized weakness, dizziness, fatigue[emedicine.medscape.com]
    • Symptoms of atrial fibrillation include shortness of breath, heart palpitations, chest discomfort, dizziness and even fainting.[advocatehealth.com]
    • But you may feel Palpitations -- an abnormal rapid heartbeat Shortness of breath Weakness or difficulty exercising Chest pain Dizziness or fainting Fatigue Confusion AF can lead to an increased risk of stroke .[medlineplus.gov]
    • This can cause problems including dizziness , shortness of breath and tiredness.[nhs.uk]
    • Other symptoms may include: A feeling of weakness Dizziness or faintness Shortness of breath Chest pain, especially in adults who are older than 65 Rarely, blood pressure may fall and cause shock.[cedars-sinai.edu]
    Confusion
    • But you may feel Palpitations -- an abnormal rapid heartbeat Shortness of breath Weakness or difficulty exercising Chest pain Dizziness or fainting Fatigue Confusion AF can lead to an increased risk of stroke .[medlineplus.gov]
    • Palpitations, which are sensations of a racing, uncomfortable, irregular heartbeat or a flip-flopping in your chest Weakness Reduced ability to exercise Fatigue Lightheadedness Dizziness Confusion Shortness of breath Chest pain Atrial fibrillation may[mayoclinic.org]
    • […] turtleneck Warning signs Even though not everybody with atrial fibrillation experiences symptoms, these warning signs may indicate heart issues: Heart palpitations (sudden pounding, fluttering, or a racing feeling in the chest) Lack of energy Lightheadedness Confusion[lifelinescreening.com]
    • Atrial fibrillation symptoms include: Heart palpitations, which feel like a fluttering or flopping in your chest or a racing, pounding or uneven heartbeat Shortness of breath Weakness Decreased blood pressure Dizziness Confusion Chest pain Passing out[uvmhealth.org]
    • Atrial Fibrillation Heart Heart palpitations Irregular pulse Dizziness or light-headedness Chest tightness Fainting Confusion Fatigue Trouble breathing Advanced age Hypertension Congestive heart failure Coronary artery disease Dysfunction of the sinus[nm.org]
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  • Entire body system
    Fatigue
    • Documentation of any previous surgical or percutaneous AF ablation procedures Palpitations Fatigue or poor exercise tolerance Presyncope or syncope Generalized weakness, dizziness, fatigue[emedicine.medscape.com]
    • Because of the overactive heart, symptoms of AF most commonly include fatigue, lightheadedness, shortness of breath and even fainting.[strokeassociation.org]
    • But you may feel Palpitations -- an abnormal rapid heartbeat Shortness of breath Weakness or difficulty exercising Chest pain Dizziness or fainting Fatigue Confusion AF can lead to an increased risk of stroke .[medlineplus.gov]
    • The primary symptoms of atrial fibrillation include racing heart rates, an irregular feeling of heart beats, fatigue, shortness of breath, mild chest tightness, and lightheadedness.[pathnetwork.org]
    Coronary Artery Disease
    • Coronary Artery Disease Coronary artery disease (CAD) refers to the narrowing or blockage of arteries in the heart.[activebeat.com]
    • Prevention Atrial fibrillation resulting from coronary artery disease can be prevented.[drugs.com]
    • Anyone with heart disease — such as heart valve problems, congenital heart disease, congestive heart failure, coronary artery disease, or a history of heart attack or heart surgery — has an increased risk of atrial fibrillation.[mayoclinic.org]
    • You're also more likely to have atrial fibrillation if you've had another heart problem, like valve disease, coronary artery disease, or heart failure.[mountsinai.org]
    • Patients with coronary artery disease may suffer angina or a heart attack when they develop AF.[health.harvard.edu]
    Weakness
    • Documentation of any previous surgical or percutaneous AF ablation procedures Palpitations Fatigue or poor exercise tolerance Presyncope or syncope Generalized weakness, dizziness, fatigue[emedicine.medscape.com]
    • But you may feel Palpitations -- an abnormal rapid heartbeat Shortness of breath Weakness or difficulty exercising Chest pain Dizziness or fainting Fatigue Confusion AF can lead to an increased risk of stroke .[medlineplus.gov]
    • Other symptoms may include: A feeling of weakness Dizziness or faintness Shortness of breath Chest pain, especially in adults who are older than 65 Rarely, blood pressure may fall and cause shock.[cedars-sinai.edu]
    • This is particularly true if a person is having bothersome symptoms (like shortness of breath or weakness) from atrial fibrillation.[drugs.com]
    • Atrial fibrillation (also called AFib or AF) is an irregular, weak heartbeat that increases the risk of heart disease and stroke .[mercy.net]
    Hypothermia
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  • Workup

    Atrial fibrillations are effectively diagnosed by an accurate medical history and a thorough physical examination. The following diagnostic methods and tests may be implored in patients presenting signs and symptoms of atrial fibrillations:

    • Electrocardiogram (ECG) is considered the primary tool in diagnosing atrial fibrillations. 
    • Holter monitor monitors a 24 hour period of cardiac electrical activity to detect intermittent AF cases.
    • Event recorder will record cardiac activities in a period of weeks to months. It comes with an access button that the patient could easily press during an event or period of chest discomfort or irregularity for real time recording of the dysrhythmia. 
    • Echocardiography elucidates the heart structures and clot formations during atrial fibrillation events [9].
    • Blood tests will determine the presence of electrolyte imbalance and hormonal hyperactivity like hyperthyroidism that can cause clinical dysrhythmias like AF.
    • Chest radiography will demonstrate other anatomic pathology of the heart, pericardium, and the lungs that may induce atrial fibrillation.

    ECG

    Abnormal ECG
    • But the paper notes that abnormal ECGs were sent to a cardiologist for review, and also says that the Kardia produced some false positives (indications of AFib that the reviewing cardiologists found to be false).[spectrum.ieee.org]
    Other ECG Findings
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  • Rhythm
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  • Test Results

    Other Test Results
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  • Jugular Venous Pressure
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  • Treatment

    The general treatment goals involved in the control of atrial fibrillation include the resetting of the heart rate and rhythm, and the active prevention of blood clot formation. Conservative approaches to atrial fibrillation using medications to control rhythm is primarily sought before invasive procedures are implored. Some patients presenting with an organic disease like hyperthyroidism that induces atrial fibrillation may be treated accordingly to relieve the heart of these unnecessary stresses.

    To reset the heart to normal rhythm, physicians often resort to cardioversion of the heart which may done by either electrical means (Electrical cardioversion), and by medical cardioversion. When the abnormal rhythm is normalized after electrical cardioversion, patients are often given antiarrhythmic drugs like flecainide, propafenone, dofetilide, and amiodarone to prevent the recurrence of the atrial dysrhythmia. Medications to control resting heart rate may be given like digoxin, beta blockers, and calcium channel blockers although proper precautions must be made to prevent hypotension [10].

    In cases, where medical cardioversion fails to achieve its goals, surgical approaches like cardiac catheter ablation, atrio-ventricular node (AV node) ablation, and surgical maze procedures may be the only options left. Patients with atrial fibrillation are at high risk for the development of thrombi and embolus from blood clots; thus, anticoagulation therapy like warfarin, dabigatran, rivaroxaban, and apixaban may be given as a preventive measure.

    Prognosis

    Atrial fibrillation is closely associated with thromboembolic events that is why patients with AF have up to 1.9 fold risk of death compared to those who don’t suffer from it [6]. Mild asymptomatic AF has a good long term prognosis. The administration of maintenance medications like rate control and anticoagulants does not increase the survival rating of AF patients that are asymptomatic [7].

    The risk of a thromboembolic stroke among AF patients beyond 75 years of age is staggering; thus, anticoagulant therapy is perpetually given unless other contraindications are identified. Meta-analysis data revealed that patients who were brought to the emergency room with myocardial infarction presenting with AF have a 40% increase in mortality rate [8].

    Complications

    Stroke
    • There it might block blood flow, causing a stroke.[mayoclinic.org]
    • Stroke Prevention in Atrial Fibrillation.[en.wikipedia.org]
    • To help raise awareness about the association between AFib and the increased risk of stroke, National Stroke Association has developed the AFib-Stroke Connection .[stroke.org]
    • AF quintuples the risk of stroke.[health.harvard.edu]
    • This type of stroke is called an embolic stroke or some doctors call it a cardioembolic stroke.[strokeassociation.org]
    Pulmonary Embolism
    • Some risk factors include COPD, pulmonary embolism, chest surgery, myocardial ischemia, cardiomyopathy, pericarditis, hypertension, atrial septal defects, mitral or aortic valve abnormalities, atrial myxoma, hyperthyroidism, alcohol, and sepsis.[medbullets.com]
    • They can travel out of the heart and get stuck in an artery to the lungs (causing a pulmonary embolism), an artery to the brain (causing a stroke) or an artery elsewhere in the body.[drugs.com]
    • embolism (NICE technology appraisal guidance 354) added to anticoagulation treatment . 8 July 2015 Atrial fibrillation: treatment and management (NICE quality standard 93) added.[pathways.nice.org.uk]
    • Additionally, lung diseases (such as pneumonia , lung cancer , pulmonary embolism , and sarcoidosis ) are thought to play a role in certain people.[en.wikipedia.org]
    • Noncardiovascular respiratory causes Pulmonary embolism , pneumonia, lung cancer, and hypothermia have been associated with AF.[emedicine.medscape.com]
    Cardiac Arrhythmia
    • Cardiac Arrhythmias Learn more about cardiac arrhythmias from electrophysiologist James Freeman, MD, co-director, Atrial Fibrillation Program.[ynhh.org]
    • We offer our expert care for AFib at the Cardiac Arrhythmia Service .[stanfordhealthcare.org]
    • Atrial fibrillation is a type of cardiac arrhythmia (abnormality of heart rate and/or rhythm).[hopkinsmedicine.org]
    • Summary: Atrial Fibrillation (AF) is the most common cardiac arrhythmia and strongly related to ageing.[umcg.nl]
    • Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia.[rnceus.com]
    Hypertension
    • For atrial fibrillation, the major risk factors are increased age (over 50), obesity, family history, hypertension , diabetes and thyrotoxicosis (an excess of thyroid hormones).[hopkinsmedicine.org]
    • Some risk factors include COPD, pulmonary embolism, chest surgery, myocardial ischemia, cardiomyopathy, pericarditis, hypertension, atrial septal defects, mitral or aortic valve abnormalities, atrial myxoma, hyperthyroidism, alcohol, and sepsis.[medbullets.com]
    • Hypertension . 2007 Feb. 49 (2):311-6.[emedicine.medscape.com]
    • Beta blockers, ACE inhibitors, and angiotensin-receptor blockers (ARBs) appear to reduce the risk of AF in patients with hypertension.[health.harvard.edu]
    • Atrial fibrillation is more likely to occur in people with other conditions, such as high blood pressure (hypertension) , atherosclerosis , or a heart valve problem.[nhs.uk]
    Asthma
    • Excessive asthma medication can also cause atrial fibrillation, but then so can poorly managed asthma.[rationalpreparedness.blogspot.com]
    • […] event Congenital heart abnormalities present (and possibly undetected) since birth Clogged arteries (atherosclerosis) Low mineral levels including potassium, magnesium and calcium High blood pressure Diabetes Thyroid problems Lung problems, including asthma[henryford.com]
    • […] failure Heart valve disease High blood pressure Coronary artery disease and heart attack Obesity Family history of atrial fibrillation Surgery on the heart History of rheumatic fever Infection, such as pneumonia or endocarditis Lung disease, such as asthma[umcvc.org]
    • Other contributing factors include: Hyperthyroidism Heart valve disease Coronary artery disease Cardiomyopathy with weakened heart muscle Chronic obstructive pulmonary disease (COPD/emphysema or asthma) Excessive alcohol consumption Cigarette smoking[strokeassociation.org]
    • Diabetes and obesity increase risk, as do medications such as bronchodilators used for asthma and COPD, decongestants, steroids, and nonsteroidal anti-inflammatory drugs.[health.harvard.edu]
    Cardiomyopathy
    • In addition, AF can be associated with hemodynamic dysfunction, tachycardia-induced cardiomyopathy, and systemic thromboembolism.[emedicine.medscape.com]
    • Some risk factors include COPD, pulmonary embolism, chest surgery, myocardial ischemia, cardiomyopathy, pericarditis, hypertension, atrial septal defects, mitral or aortic valve abnormalities, atrial myxoma, hyperthyroidism, alcohol, and sepsis.[medbullets.com]
    • Michaud You have access Restricted access Clinical Profile and Consequences of Atrial Fibrillation in Hypertrophic Cardiomyopathy Ethan J.[circ.ahajournals.org]
    • Complications of AF include haemodynamic instability, cardiomyopathy, cardiac failure, and embolic events such as stroke.[lifeinthefastlane.com]
    • […] following treatment failure The atrial fibrillation Heart Team Hybrid rhythm control therapy Combining antiarrhythmic drugs and catheter ablation Combining antiarrhythmic drugs and pacemakers Specific situations Frail and ‘elderly’ patients Inherited cardiomyopathies[escardio.org]
    Myocarditis
    • […] of rheumatic mitral valve disease, a prosthetic heart valve , or mitral valve repair Secondary AF – occurs in the setting of a primary condition that may be the cause of the AF, such as acute myocardial infarction , cardiac surgery , pericarditis , myocarditis[en.wikipedia.org]
    • Inflammation Myocarditis and pericarditis may be idiopathic or may occur in association with collagen vascular diseases; viral or bacterial infections; or cardiac, esophageal, or thoracic surgery.[emedicine.medscape.com]
    Pulmonary Edema
    • Occasionally, patients present with extreme manifestations of hemodynamic compromise, such as chest pain, pulmonary edema, or syncope.[clevelandclinicmeded.com]
    • Lung exam may reveal crackles, which are suggestive of pulmonary edema .[en.wikipedia.org]
    Syncope
    • Documentation of any previous surgical or percutaneous AF ablation procedures Palpitations Fatigue or poor exercise tolerance Presyncope or syncope Generalized weakness, dizziness, fatigue[emedicine.medscape.com]
    • Presentation can be asymptomatic, but common symptoms include dyspnea, palpitations, chest pain, or syncope.[medbullets.com]
    • Occasionally, patients present with extreme manifestations of hemodynamic compromise, such as chest pain, pulmonary edema, or syncope.[clevelandclinicmeded.com]
    Angina Pectoris
    • When symptoms do occur, there may be palpitations (awareness of a rapid heartbeat), fainting, dizziness, weakness, shortness of breath and angina pectoris (chest pain caused by a reduced blood supply to the heart muscle).[hopkinsmedicine.org]
    Atrial Flutter
    • For example, strokes are also a concern in someone with atrial flutter.[mayoclinic.org]
    • Atrial Flutter Atrial flutter is a regular rhythm with characteristic "flutter" waves in a sawtooth pattern.[merckmanuals.com]
    • Decsription, Atrial Flutter Atrial flutter is a rhythm closely related to atrial fibrillation.[equimedcorp.com]
    • Atrial flutter Atrial flutter is less common than atrial fibrillation, but shares the same symptoms, causes and possible complications.[nhs.uk]
    Atrial Arrhythmia
    • arrhythmias in grown-up patients with congenital heart disease Management of atrial flutter Patient involvement, education and self-management Patient-centred care Integrated patient education Self-management and shared decision-making Gaps in evidence[escardio.org]
    • Treatment of the underlying disorder is important but does not always alleviate atrial arrhythmias.[merckmanuals.com]
    Atrial Fibrillation
    • Possible causes of atrial fibrillation include: However, some people who have atrial fibrillation don't have any heart defects or damage, a condition called lone atrial fibrillation.[mayoclinic.org]
    • Episodes of atrial fibrillation can come and go, or you may develop atrial fibrillation that doesn't go away and may require treatment.[mayoclinic.org]
    • Intermittent atrial fibrillation is often called "paroxysmal atrial fibrillation."[verywell.com]
    Coronary Artery Disease
    • Coronary Artery Disease Coronary artery disease (CAD) refers to the narrowing or blockage of arteries in the heart.[activebeat.com]
    • Prevention Atrial fibrillation resulting from coronary artery disease can be prevented.[drugs.com]
    • Anyone with heart disease — such as heart valve problems, congenital heart disease, congestive heart failure, coronary artery disease, or a history of heart attack or heart surgery — has an increased risk of atrial fibrillation.[mayoclinic.org]
    • You're also more likely to have atrial fibrillation if you've had another heart problem, like valve disease, coronary artery disease, or heart failure.[mountsinai.org]
    • Patients with coronary artery disease may suffer angina or a heart attack when they develop AF.[health.harvard.edu]
    Transient Ischemic Attack
    • Such risk factors include age 65 or older, high blood pressure, diabetes, heart failure, a previous stroke or transient ischemic attack, vascular disease, and being female.[merckmanuals.com]
    • Emboli in the brain may result in an ischemic stroke or a transient ischemic attack (TIA).[en.wikipedia.org]
    • Risk factor Points Age 75 or above 1 Diabetes 1 Heart failure 1 Hypertension 1 Previous stroke or transient ischemic attack (TIA, or "mini-stroke") 2 Patients with a CHADS2 score of 0 do not need anticoagulants; those with a score of 1 may take aspirin[health.harvard.edu]
    • ischemic attack (TIA), systemic thromboembolism, or age 75 years or older Moderate-risk factors: Age 65-74 years, female sex, hypertension, diabetes mellitus, heart failure, arterial disease (prior myocardial infarction, peripheral arterial disease,[emedicine.medscape.com]
    Rheumatic Heart Disease
    • When rheumatic heart disease is the cause, the condition may be treated with surgery to replace heart valves damaged by the disease.[drugs.com]
    • heart disease Pericarditis Hyperthyroidism Excessive alcohol consumption Family history Overview Your heart’s electrical system (called the conduction system) sends signals from the top chambers of heart (atria) at regular intervals to control the rhythm[nm.org]
    • Among the most important are atherosclerosis, rheumatic heart disease, and vascular inflammation.[britannica.com]
    • Some of the risks include: Older age High blood pressure Coronary artery disease Heart failure Rheumatic heart disease (from previous Streptococcus infection) Heart valve defects (like mitral valve prolapse) Pericarditis Congenital heart defects Sick[massgeneral.org]
    • ., due to rheumatic heart disease or mitral valve prolapse ), mitral regurgitation , left atrial enlargement , hypertrophic cardiomyopathy (HCM), pericarditis , congenital heart disease , and previous heart surgery .[en.wikipedia.org]
    Hypothermia
    Bradycardia
    • Bradycardia is most often treated with a pacemaker to keep the heart beating at a regular pace.[columbiasurgery.org]
    • Slow heart rates are called bradycardias.[ucsfhealth.org]
    • Unlike sotalol, however, it does not cause excessive bradycardia and thus can be administered to patients without concern for exacerbating pre-existing bradycardia.[clevelandclinicmeded.com]

    Etiology

    Atrial fibrillation may be induced by any of these conditions:

    Causes

    Hypertension
    • For atrial fibrillation, the major risk factors are increased age (over 50), obesity, family history, hypertension , diabetes and thyrotoxicosis (an excess of thyroid hormones).[hopkinsmedicine.org]
    • Some risk factors include COPD, pulmonary embolism, chest surgery, myocardial ischemia, cardiomyopathy, pericarditis, hypertension, atrial septal defects, mitral or aortic valve abnormalities, atrial myxoma, hyperthyroidism, alcohol, and sepsis.[medbullets.com]
    • Hypertension . 2007 Feb. 49 (2):311-6.[emedicine.medscape.com]
    • Beta blockers, ACE inhibitors, and angiotensin-receptor blockers (ARBs) appear to reduce the risk of AF in patients with hypertension.[health.harvard.edu]
    • Atrial fibrillation is more likely to occur in people with other conditions, such as high blood pressure (hypertension) , atherosclerosis , or a heart valve problem.[nhs.uk]
    Hyperthyroidism
    • Some conditions associated with atrial fibrillation are: mitral stenosis, lung disease, heart disease, sepsis, hyperthyroidism and cardiac surgery.[rnceus.com]
    • They can also be caused by another conditions, such as alcohol abuse, an overactive thyroid gland ( hyperthyroidism ), or a birth defect affecting the heart.[cedars-sinai.edu]
    • If hyperthyroidism is the cause of AF, treating the thyroid condition may be enough to make AF go away.[strokeassociation.org]
    • Some risk factors include COPD, pulmonary embolism, chest surgery, myocardial ischemia, cardiomyopathy, pericarditis, hypertension, atrial septal defects, mitral or aortic valve abnormalities, atrial myxoma, hyperthyroidism, alcohol, and sepsis.[medbullets.com]
    • […] heart attack Obesity Family history of atrial fibrillation Surgery on the heart History of rheumatic fever Infection, such as pneumonia or endocarditis Lung disease, such as asthma or chronic obstructive pulmonary disease Metabolic conditions, such as hyperthyroidism[umcvc.org]

    Epidemiology

    In the United States alone, more than 2.2 million Americans are suffering from atrial fibrillation. This cardiac dysfunction is primarily age related, because a fourth of the patients beyond 40 years old are at risk of developing atrial fibrillation in their remaining lifetime [2].

    The increasing prevalence of atrial fibrillation among the elderly population is expected to double by 2050 in the US. Atrial fibrillation is relatively rare in infants and childhood, except for those who have undergone prior cardiac surgery [3]. Atrial fibrillation is more common among males than in females, and it is commonly seen in the white race than the black. Patients reaching the seventh decade the prevalence doubles per 10 year increment [4].

    Sex distribution
    Age distribution

    Pathophysiology

    Arial fibrillation is strongly associated with cardiovascular diseases like coronary artery diseases (CAD), congestive heart failure (CHF) and diabetes mellitus [5]. Although the exact mechanism is inconclusively elaborated, theories abound that excessive catecholamine, hemodynamic stress and cardiac inflammation causes the AF phenomenon. There are theories of the occurrence of an automatic focus of electrical conduction from sources other than the AV node like some focal regions in the pulmonary vein can cause the unsynchronized impulses that gives rise to AF.

    Prevention

    The active prevention of heart diseases through a heart friendly diet, exercise, and lifestyle may prevent occurrence of an acquired atrial fibrillation. A healthy lifestyle connotes the willful avoidance of stimulants like caffeine, alcohol and tobacco. Regular exercises and physical activity to maintain ideal body weight is also paramount in the prevention of heart diseases. Patients must understand that severe anger and stress can directly cause heart rhythm dysfunction on a long term basis.

    Summary

    Atrial fibrillation (AF) is clinically defined as a fast and irregular heart rate that reduces blood flow all over the body. Although atrial fibrillation is not considered life-threatening, persistent symptoms may require immediate treatment to prevent serious complications.

    The desynchronized atrial contraction in atrial fibrillation may lead to thrombi or emboli formation that can functionally obstruct blood flow in multiple distant organs and cause ischemia. Atrial fibrillation is often times approached by interventions and medications to normalize the cardiac electrical activities. Atrial fibrillation is classified into three patterns: Paroxysmal AF, persistent AF, and permanent AF [1].

    Patient Information

    Definition

    Atrial fibrillation is clinically defined as a fast and irregular heart rate that reduces blood flow all over the body.

    Cause

    Atrial fibrillation may be triggered by an ongoing heart disease, metabolic disease, neurologic disorders, and the intake of stimulants.

    Symptoms

    Patients may be asymptomatic, or may complain of palpitation, dizziness and weakness.

    Diagnosis

    Electrocardiography, echocardiography, Holter monitoring, blood tests and a chest X-ray may be used to diagnose the condition.

    Treatment and follow-up

    Medical and electrical cardioversion, and cardiac surgery ablation are the most common treatment options.

    Other symptoms

    Digoxin
    • Digoxin, beta-adrenergic blockers, calcium channel blockers may be used to reduce the rate of AV conduction to 80-100 beats/minute.[rnceus.com]
    • “Sagging” ST segment depression is visible in V6, II, III and aVF, suggestive of digoxin effect .[lifeinthefastlane.com]
    • Hemodynamically stable patients should be rate-controlled with beta-blockers, diltiazem, or digoxin (in order of preference).[medbullets.com]
    • Digoxin: Digoxin slows the heart rate by blocking electrical impulses.[uwmedicine.org]
    • These drugs may include beta-blockers, calcium channel blockers, and digoxin.[nytimes.com]

    Self-assessment

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    References

    1. Fuster V, Rydén LE, Asinger RW, et al. ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary 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 and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology. Circulation. Oct 23 2001; 104(17):2118-50.
    2. Lloyd-Jones DM, Wang TJ, Leip EP, Larson MG, Levy D, Vasan RS, et al. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation. Aug 31 2004; 110(9):1042-6.
    3. Abdel Latif A, Messinger-Rapport BJ. Should nursing home residents with atrial fibrillation be ant coagulated? Cleve Clin J Med. Jan 2004; 71(1):40-4.
    4. Rathore SS, Berger AK, Weinfurt KP, Schulman KA, Oetgen WJ, Gersh BJ, et al. Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes. Circulation. Mar 7 2000; 101(9):969-74.
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