Signs and Symptoms of Atrial Fibrillation

Some patients with atrial fibrillation (AF) may have minimal or no symptoms where others may have severe symptoms especially at the onset of the arrhythmia. At onset, patients may complain of symptoms such as palpitations, shortness of breath, cough, dizziness, fainting, and angina and then as the atrial fibrillation persists, the patient may complain of fatigue, shortness of breath, and may show signs of pulmonary edema (fluid in the lungs.

Signs and symptoms of atrial fibrillation may include:

• Palpitations
• Fatigue
• Exercise intolerance
• Shortness of breath
• Light headedness
• Cough
• Dizziness
• Syncope (fainting)
• Hypotension (low blood pressure)
• Angina (pain, pressure, or discomfort in the chest)
• Congestive heart failure (CHF)
• Pulmonary edema
• Anxiety

It is not uncommon, however, for persons with atrial fibrillation to have no symptoms whatsoever - a condition known as asymptomatic or silent atrial fibrillation. Studies have shown that the incidence of asymptomatic atrial fibrillation ranges from 10% to 40%. When symptoms of atrial fibrillation do occur, they may be non-specific and initially not be suspected to be related to an abnormality of the heart (i.e., AF).

Patient History and Physical Examination

The initial diagnostic workup for patients with first detected atrial fibrillation (i.e., when the health care provider first becomes aware of the patient's atrial fibrillation) focuses on the following areas:

• Patient History
  • type of symptoms associated with atrial fibrillation
  • when symptoms first started
  • how long symptoms last
  • how frequently symptoms occur
  • any factors that may precipitate symptoms
  • any factors that may terminate symptoms
  • previous medication history
  • clinical classification of atrial fibrillation (e.g., first episode; paroxysmal; persistent; permanent)
• Physical Examination - The goal of the physical examination is to determine whether the patient may have another underlying condition that is the root cause of the atrial fibrillation. In performing the physical examination, the health care provider will look for signs of:
  • atherosclerosis and heart failure (e.g., arterial bruits; jugular vein distension; swelling of the extremities)
  • rheumatic heart disease/mitral stenosis
  • hypertension
  • hyperthyroidism

Laboratory studies (e.g., blood tests) are done to check for the presence of underlying conditions which may trigger the atrial fibrillation. These tests may include:

• Electrolyte levels (e.g., potassium, sodium)
• Magnesium levels
• Blood glucose levels - to check for diabetes
• Blood Urea Nitrogen (BUN) - a test of kidney function
• Complete blood count
• Thyroid function tests
• Cardiac enzymes (evaluation of an acute event)
• Blood alcohol level (if deemed appropriate, in an acute event)

• Electrocardiogram (EKG)
• 24 hour Holter Monitor
• Transesophageal echocardiography (TEE)

An electrocardiogram (EKG) is a test that measures and records the electrical activity of the heart. An EKG not only confirms the presence of atrial fibrillation but also reveals other useful information such as a previous heart attack and/or hypertrophy (an abnormal enlargement) of the left ventricle.