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What are the symptoms of atrial fibrillation?

Many patients with atrial fibrillation have no symptoms and are unaware of the abnormal heart rhythm. The most common symptom of atrial fibrillation is palpitations, an uncomfortable awareness of the rapid and irregular heartbeat. Other symptoms of atrial fibrillation are caused by the diminished delivery of blood to the body. These symptoms include dizziness, fainting, weakness, fatigue, shortness of breath, and angina (chest pain due to reduced blood flow to the heart muscles).

What are the complications of atrial fibrillation?

Heart Failure

If the heart is unable to pump an adequate amount of blood to the body, as in some people with AF, the body begins to compensate by retaining fluid. This can lead to a condition called heart failure. Heart failure results in the accumulation of fluid in the lower legs (edema) and the lungs (pulmonary edema). Pulmonary edema makes breathing more difficult and reduces the ability of the lung to add oxygen to and remove carbon dioxide from the blood. The levels of oxygen in the blood can drop, and the levels of carbon dioxide in the blood can rise, a complication called respiratory failure. This is a life-threatening complication.

Stroke

Quivering of the atria in AF cause blood inside the atria to stagnate. Stagnant blood tends to form blood clots along the walls of the atria. Sometimes, these blood clots dislodge, pass through the ventricles, and lodge in the brain, lungs, and other parts of the body. This process is called embolization. One common complication of AF is a blood clot that travels to the brain and causes the sudden onset of one-sided paralysis of the extremities and/or the facial muscles (an embolic stroke). A blood clot that travels to the lungs can cause injury to the lung tissues (pulmonary infarction), and symptoms of chest pain and shortness of breath. When blood clots travel to the body's extremities, cold hands, feet, or legs may occur suddenly because of the lack of blood.
What are the risk factors for developing atrial fibrillation?

There are many risk factors for developing atrial fibrillation. These risk factors are:

Increased age (1% of people over 60 years of age have atrial fibrillation)
Coronary heart disease (including heart attack)
High blood pressure
Abnormal heart muscle function (including congestive heart failure)
Disease of the mitral valve between the left and right ventricle
An overactive thyroid gland (hyperthyroidism )or overdose of thyroid medication
Low amounts of oxygen in the blood, for example, as occurs with lung diseases such as emphysema or chronic obstructive pulmonary disease (COPD)
Inflammation of the lining surrounding the heart (pericarditis)
Blood clots in the lung (pulmonary embolism)
Chronic lung diseases (emphysema, asthma, COPD)
Excessive intake of alcohol (alcoholism)
Stimulant drug use such as cocaine or decongestants
Recent heart or lung surgery
Abnormal heart structure from the time of birth (congenital heart disease)
About 1 in 10,000 otherwise healthy, young adults have AF without any apparent cause or underlying heart disease. AF in these individuals usually is intermittent, but can become chronic in 25%. This condition is referred to as lone AF. Stress, alcohol, tobacco, or use of stimulants may play a role in causing lone AF.

How is atrial fibrillation diagnosed?

AF can be chronic and sustained, or brief and intermittent (paroxysmal). Paroxysmal AF refers to intermittent episodes of AF lasting, for example, minutes to hours. The heart rate reverts to normal between episodes. In chronic, sustained AF, the atria fibrillate all of the time. Chronic, sustained AF is not difficult to diagnose. Doctors can hear the rapid and irregular heartbeats using a stethoscope. Abnormal heartbeats also can be felt by taking a patient's pulse.

EKG (electrocardiogram)

An electrocardiogram (EKG) is a brief recording of the heart's electrical discharges. The irregular EKG tracings of AF are easy to recognize provided AF occurs during the EKG.

Holter monitor

If episodes of AF occur intermittently, a standard EKG performed at the time of a visit to the doctor's office may not show AF. Therefore, a Holter monitor, a continuous recording of the heart's rhythm for 24 hours, often is used to diagnose intermittent episodes of AF.

Patient-activated event recorder

If the episodes of AF are infrequent, a 24-hour Holter recording may not capture these sporadic episodes. In this situation, the patient can wear a patient-activated event recorder for 1 to 4 weeks. The patient presses a button to start the recording when he or she senses the onset of irregular heartbeats or symptoms possibly possible caused by AF. The doctor then analyzes the recordings at a later date.

Echocardiography

Echocardiography uses ultrasound waves to produce images of the heart's chambers and valves and the lining around the heart (pericardium). Conditions that may accompany AF such as mitral valve prolapse, rheumatic valve diseases, and pericarditis (inflammation of the "sack" surrounding the heart) can be detected with echocardiography. Echocardiography also is useful in measuring the size of the atrial chambers. Atrial size is an important factor in determining how a patient responds to treatment for AF. For instance, it is more difficult to achieve and maintain a normal heart rhythm in patients with enlarged atria.

Transesophageal echocardiography (TEE)

Transesophageal echocardiography (TEE) is a special echocardiographic technique that involves taking pictures of the atria using sound waves. A special probe that generates sound waves is placed in the esophagus (the food pipe connecting the mouth to the stomach). The probe is located at the end of a long flexible tube that is inserted through the mouth into the esophagus. This technique brings the probe very close to the heart (which lies just in front of the esophagus). Sound waves generated by the probe are bounced off of the structures within the heart, and the reflected sound waves are used to form a picture of the heart. TEE is very accurate for detecting blood clots in the atria as well as for measuring the size of the atria.

As previously discussed, blood may clot in the atria during AF, and pieces of the clot may dislodge and travel to the brain, causing a stroke. Doctors are especially concerned about blood clots dislodging during or after cardioversion (the conversion of AF back into a normal heart rhythm with either drugs or electrical shocks). Moreover, doctors believe that resumption of atrial contractions after successful cardioversion increases the likelihood that pieces of clot will dislodge. For these reasons, anticoagulation (thinning) of blood usually is done prior to cardioversion. This prevents new clot from forming while the old clot dissolves or solidifies so that pieces cannot break off. If no clots are detected in the atria by TEE, the risk of stoke after cardioversion is believed to be lower. Thus, some doctors use TEE to determine the risk of stroke following cardioversion. Studies are underway to determine whether patients with a normal TEE (no blood clots) need to have their blood thinned prior to cardioversion.

Other tests

High blood pressure and signs of heart failure can be ascertained (determined) during a physical examination of the patient. Blood tests are performed to detect abnormalities in blood oxygen and carbon dioxide levels, electrolytes, and thyroid hormone levels. Chest x-rays reveal enlargement of the heart, heart failure, and other diseases of the lung. Exercise treadmill testing (a continuous recording of the EKG during exercise) is a useful screening study for detecting severe coronary artery disease.