This will include questions about A-fib symptoms and their frequency, and questions about other risk factors. In addition, the doctor may ask about eating and exercise habits, alcohol consumption, and any tobacco or recreational drug use. They may also ask about a family history of A-fib. This is because people who have relatives with A-fib may have an increased risk of developing the condition.
Answering these questions can help the doctor identify any potential signs of A-fib or another condition and assess the overall risk. The clearest physical sign of A-fib is an irregular heart rhythm.
They can also listen to the rhythm and rate of heartbeats with a stethoscope. As part of the examination, the doctor will assess other physical markers that may indicate a problem with heart function. They may measure blood pressure, check for heart murmurs, and look for evidence of heart failure. The doctor will also look for signs of health conditions that can cause or contribute to A-fib, such as hyperthyroidism, which is an overactive thyroid gland.
Learn more about hyperthyroidism here. To diagnose A-fib, find its most likely cause, and identify any complications, a doctor may order:. An electrocardiogram: An electrocardiogram EKG records the electrical activity of the heart. Doctors often use this to confirm initial pulse rate evaluations. When someone has A-fib, the EKG will identify an irregular rhythm.
This means that heartbeats do not have a regular pattern. Holter monitoring: A Holter monitor is a portable EKG monitor that a person wears to record their heart rhythm and rate, usually for 24—48 hours. It can help document A-fib that occurs intermittently or has no symptoms.
The longer a person wears the monitor, the higher the sensitivity of detection. Event recorder: A person may need to wear this heart rate and rhythm monitor for weeks or even months. It may record on its own, or the person may need to push a button to start recording when they experience symptoms. This is effective for people who have arrhythmia intermittently. Echocardiogram: An echocardiogram uses sound waves to produce a moving picture of the heart.
This can help doctors see any blockages within the heart, such as blood clots. This test may involve moving a wand-like tool called a transducer around the outside of the chest. Check pulse, blood pressure, and lungs.
Typically, this is one of the first things your doctor will do to rule out other conditions that could be masquerading as a heart rhythm disorder. Stress testing. Also known as exercise testing, a stress test involves measuring how your heart behaves during cardiovascular exercise.
This could take place on a treadmill or another cardio machine. Holter monitor or event monitor. You would wear these sorts of monitors on your body for a longer stretch of time to catch and record an AFib event. Clinical tests are often effective — but not always. EKGs are helpful, but even computers can make mistakes.
This is why relaying an accurate and complete family history is so important for the right diagnosis. Medical conditions often occur alongside each other, which can complicate diagnosis. Tachycardia and other arrhythmias. Tachycardia can come from an infection, heart disease, congenital abnormalities , or a number of other causes, and can easily be mistaken for persistent AFib.
Anxiety or panic attacks. Anxiety and AFib go hand-in-hand for many people. Surgical treatments for atrial fibrillation are invasive, high risk, and should be considered only in patients undergoing cardiac surgery for other reasons. The maze procedure aims to eliminate atrial fibrillation through the use of incisions in the atrial wall to interrupt arrhythmogenic wavelet pathways and reentry circuits.
Two percutaneously inserted devices, the Watchman and the Amplatzer Cardiac Plug, can be used to achieve occlusion of the LAA, although the latter is not available in the United States.
Both are non-inferior to warfarin Coumadin in stroke risk reduction. Anticoagulation is an essential part of atrial fibrillation management. It significantly reduces the risk of embolic stroke, but increases the risk of bleeding. Although the benefit of anticoagulation exceeds the risk of bleeding for most patients, discussions about stroke prevention vs. Tools to aid in the assessment of the risks of stroke and bleeding are available and are useful in making decisions with patients about therapeutic options.
For many years, the CHADS 2 congestive heart failure; hypertension; age 75 years or older; diabetes mellitus; prior stroke, transient ischemic attack, or thromboembolism [doubled] scoring system has been used to estimate risk of stroke in patients with atrial fibrillation. Anticoagulation is recommended for patients with a CHADS 2 score of 2 or more, unless a contraindication is present.
Vascular disease prior myocardial infarction, peripheral artery disease, aortic plaque. Similar clinical tools are available to assess anticoagulation bleeding risk. Warfarin lowers the risk of thromboembolic events, 36 — 39 but it has a narrow therapeutic range, multiple drug and food interactions, and requires frequent blood monitoring of the international normalized ratio. Direct oral anticoagulants, including a direct thrombin and several factor Xa inhibitors, are available. Their major drawbacks are higher costs, difficulty reversing their effect in emergency situations, and the lack of simple blood tests to check drug levels.
A specific antidote for dabigatran is available, and factor Xa inhibitor antidotes are in the late stages of development. The oral direct thrombin inhibitor dabigatran is as effective as warfarin in preventing stroke and systemic emboli. Major bleeding events were similar to those of warfarin, with fewer intracranial bleeds 0.
These oral anticoagulants also have a slightly lower risk of intracranial hemorrhage compared with warfarin 0. Table 3 outlines the pharmacologic properties of direct oral anticoagulants and warfarin 16 ; none are recommended for patients on hemodialysis, nor are they approved for use during pregnancy or in patients with valvular atrial fibrillation or advanced kidney disease. Table 4 compares some of the risks and benefits of direct oral anticoagulants vs. Variable dose adjusted to international normalized ratio.
Generic prices not available; brand price listed in parentheses. Educate patients and check for interactions. Anticoagulation in atrial fibrillation. Information from references 40 , 41 , 43 , 45 , and Although current practice has been to use heparin or low-molecular-weight heparin to bridge anticoagulation when patients taking warfarin need surgery or invasive procedures, a recent randomized trial in patients with atrial fibrillation who were undergoing surgery and who were at low or moderate bleeding risk found that these patients had worse outcomes if bridged than those who had their anticoagulation stopped during the perioperative period.
Patients with a very high risk of stroke or thromboembolism and those undergoing cardiac, spinal, or intracranial surgery were excluded from the study. The treatment of nonvalvular atrial fibrillation must be individualized to each patient's condition, which can change over time. Referral to a cardiologist is warranted for patients with complex cardiac disease; those who cannot tolerate atrial fibrillation despite rate control; those who need rhythm control, require ablation therapy, or may benefit from surgical treatment; and those who need a pacemaker or defibrillator because of another rhythm abnormality.
Data Sources: A PubMed search was completed in Clinical Queries using the terms atrial fibrillation, rate control, rhythm control, ablation therapy on nonvalvular atrial fibrillation, and anticoagulation therapy for nonvalvular atrial fibrillation. The search focused on randomized controlled clinical trials, systematic reviews, meta-analyses, and reviews published since Search dates: January to June Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. Reprints are not available from the authors.
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