Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • worsening heart failure or pulmonary symptoms

Other diagnostic factors

  • palpitations
  • fatigue or lightheadedness
  • jugular venous pulsations with rapid flutter waves
  • chest pain
  • dyspnoea
  • syncope
  • hypotension
  • embolic events

Risk factors

  • increasing age
  • valvular dysfunction
  • atrial septal defects
  • atrial dilation
  • recent cardiac or thoracic procedures
  • surgical or post-ablation scarring of atria
  • heart failure
  • hyperthyroidism
  • COPD
  • asthma
  • pneumonia
  • anti-arrhythmic drugs for atrial fibrillation
  • diabetes
  • digitalis use
  • male sex
  • congenital or lone atrial flutter

Diagnostic investigations

1st investigations to order

  • ECG
  • TFTs
  • serum electrolytes
  • CXR
Full details

Investigations to consider

  • PFTs
  • digitalis level
  • cardiac enzymes
  • spiral CT with pulmonary embolism protocol
  • trans-thoracic echocardiogram
  • atrial electrogram recording
  • electrophysiological studies
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Associate Professor of Medicine

Johns Hopkins University

School of Medicine

Baltimore

MD

Disclosures

KCW declares that she has no competing interests.

Peer reviewers VIEW ALL

Associate Professor of Medicine

Director

Cardiac Electrophysiology Laboratory

UT Southwestern Medical Center

University Hospital

St. Paul

Dallas

TX

Disclosures

RCW declares that he has no competing interests.

Clinical Assistant Professor

Department of Medicine

Thomas Jefferson University Hospital

Philadelphia

PA

Disclosures

RH declares that he has no competing interests.

Director of Electrophysiology

Long Island Arrhythmia Center

Mineola

NY

Disclosures

GJ declares that he has no competing interests.

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