Last reviewed: 21 Aug 2021
Last updated: 26 Aug 2021

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 or cannon waves
  • chest pain
  • dyspnoea
  • syncope
  • hypotension
  • embolic events
  • myocardial ischaemia

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
  • full blood count
  • thyroid function tests
  • renal function and serum electrolytes
  • chest x-ray
  • transthoracic echocardiography (TTE)

Investigations to consider

  • pulmonary function tests
  • digitalis level
  • high-sensitivity troponin
  • CT pulmonary angiography with clinical probability scoring
  • electrophysiological studies
  • atrial electrogram
  • exercise tolerance testing
  • myocardial ischaemia testing

Treatment algorithm

Contributors

Expert advisers

Resham Baruah, MBBS, BSc MRCP, PhD

Consultant Cardiologist

Chelsea and Westminster Hospital NHS Foundation Trust

Royal Brompton & Harefield NHS Foundation Trust

London

UK

Biography

RB is specialist advisor to the 2018 NICE guideline on chronic heart failure in adults and is a member of the European Heart Failure Association Task Force on palliative care in heart failure.

Disclosures

RB has received honoraria/speakers’ fees from Novartis and Boehringer Ingelheim.

Acknowledgements

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

Katherine C. Wu, MD, FACC

Associate Professor of Medicine

Johns Hopkins University School of Medicine

Baltimore

MD

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 and speaker for BMS/Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo, for which no fees are received personally.

Editors

Annabel Sidwell,

Section Editor, BMJ Best Practice

Disclosures

AS declares that she has no competing interests.

Rachel Wheeler,

Lead Section Editor, BMJ Best Practice

Disclosures

RW 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.

Use of this content is subject to our disclaimer