Atrial Fibrillation

Description

Atrial fibrillation (AF) is a chronic or paroxysmal arrhythmia characterized by chaotic electrical activity. The electrophysiologic mechanism is most likely multiple reentrant wavelets within the atria. Because the AV node is bombarded with nearly continuous atrial electrical impulses, the ventricular response is irregular and usually rapid (up to or exceeding 180 beats per minute). Symptoms vary from none to mild (palpitations, lightheadedness, fatigue, poor exercise capacity) to severe (angina, dyspnea, syncope), and are frequently more serious in patients with significant structural heart disease. In some patients with Wolff- Parkinson-White syndrome, AF may be extremely rapid and degenerate into ventricular fibrillation.

Thromboembolism is the most important complication in patients with atrial fibrilation (AF).

Causes

Causes of AF include: Hypertensive heart disease; Valvular or rheumatic heart disease; Coronary artery disease; Acute myocardial infarction; Pulmonary embolus; Cardiomyopathy; Congestive heart failure; Infiltrative heart disease; Pericarditis; Intoxication/ingestion (e.g., ethanol in "Holiday Heart"); Hyperthyroidism; Postoperative state (especially cardiothoracic surgery); Sick sinus syndrome (tachycardia-bradycardia syndrome); and Idiopathic (including "lone" atrial fibrillation).

Risk factors include: Hypertension; Diabetes mellitus; Left ventricular hypertrophy; Coronary artery disease; Congestive heart failure; and Rheumatic heart disease.

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Conventional Labs

An ECG is diagnostic. A Holter monitor and event monitor may be helpful in diagnosing paroxysmal atrial fibrillation (PAF). An echocardiogram is used to assess for structural heart disease.

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