Last reviewed: 31 Jun 2021
Last updated: 04 Jun 2021

Summary

Definition

History and exam

Key diagnostic factors

  • palpitations
  • irregular pulse rate
  • risk factors

Other diagnostic factors

  • breathlessness/dyspnoea
  • symptomatic hypotension
  • chest pain/tightness/discomfort
  • fatigue
  • anxiety
  • cognitive impairment
  • dizziness
  • polyuria
  • abnormal breath sounds
  • additional heart sounds
  • elevated jugular venous pressure
  • evidence of stroke
  • pre-syncope and syncope

Risk factors

  • increasing age
  • hypertension
  • heart failure
  • diabetes mellitus
  • obstructive sleep apnoea
  • obesity
  • coronary artery disease
  • valve disease
  • other cardiac disease
  • regular, heavy alcohol consumption
  • cardiac or thoracic surgery
  • other atrial arrhythmias
  • previous stroke/transient ischaemic attack
  • hyperthyroidism
  • athletic levels of physical activity
  • COPD
  • smoking

Diagnostic investigations

1st investigations to order

  • ECG
  • FBC
  • clotting profile
  • electrolytes, urea, and creatinine
  • thyroid function
  • CXR
  • transthoracic echocardiography (TTE)

Investigations to consider

  • cardiac troponin
  • ABG
  • CRP
  • B-natriuretic peptide (BNP)/N-terminal prohormone B-natriuretic peptide (NT-pro-BNP)
  • LFTs
  • erythrocyte sedimentation rate
  • transoesophageal echocardiogram (TOE)
  • inpatient telemetry or 24-hour holter monitor
  • coronary angiography (CT or conventional) or stress testing
  • late gadolinium contrast-enhanced cardiac MR (CMR)
  • brain CT
  • brain MRI
  • computed tomographic pulmonary angiography (CTPA)

Treatment algorithm

Contributors

Expert advisers

Resham Baruah, MBBS, BSc, MRCP, PhD

Consultant Cardiologist

Chelsea and Westminster Hospital and the Royal Brompton and Harefield NHS Trust

London

UK

Disclosures

RB has received honorarium/speaker fees from Novartis and Boehringer Ingleheim.

Adam D. Hartley, MBBS, BSc, MRCP

Wellcome Trust Clinical Research Fellow

Imperial College London

Specialist Registrar in Cardiology

Imperial College Healthcare NHS Trust

London

UK

Disclosures

ADH declares that he has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work is retained in parts of the content:

Arti N. Shah, MS, MD

Director

Cardiac Electrophysiology

Elmhurst Hospital Center

Elmhurst

Assistant Professor of Medicine

Mount Sinai School of Medicine

New York

NY

ANS is an author of a number of references cited in this topic.

Bharat K. Kantharia MD, FRCP, FAHA, FACC, FESC, FHRS

Cardiovascular and Heart Rhythm Consultant

Attending and Consultant Cardiac Electrophysiologist

Mount Sinai Hospitals

New York Methodist Hospital

New York

NY

West Houston Medical Center

Memorial Hermann Hospital

Houston

TX

BKK is an author of a number of references cited in this topic.

Peer reviewers

Gregory Lip, MD, FRCP, DFM, FACC, FESC, FEHRA

Price-Evans Professor of Cardiovascular Medicine

University of Liverpool

Senior Investigator

National Institute for Health Research

UK

Distinguished Professor

Faculty of Medicine

Aalborg University

Denmark

Adjunct Professor

Yonsei University

Seoul

South Korea

Disclosures

GL is a consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon, and Daiichi-Sankyo. He is a speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are directly received personally. GL is an author of a number of references cited in this topic.

Editors

Tannaz Aliabadi-Oglesby,

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

Disclosures

RW declares that she has no competing interests.

Jo Haynes,

Head of Editorial, BMJ Knowledge Centre

Disclosures

JH declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

Shouvik Haldar,

Consultant Cardiologist and Electrophysiologist

Royal Brompton and Harefield Hospitals

London

UK

Disclosures

SH was a Section Editor, BMJ Best Practice. SH declares that he has no competing interests.

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