Last reviewed: 21 Sep 2021
Last updated: 09 Jun 2021



History and exam

Key diagnostic factors

  • presence of valvular heart disease, coronary artery disease, hypertension, pericarditis, cardiomyopathy, and other arrhythmias
  • presence of diabetes mellitus, thyroid disease, alcohol abuse, and cancer
  • palpitations
  • tachycardia
  • irregular pulse

Other diagnostic factors

  • stroke
  • shortness of breath
  • fatigue
  • chest pain
  • dizziness
  • hypotension
  • elevated jugular venous pressure
  • murmur or gallop rhythm
  • rales
  • decrease in mentation or listlessness

Risk factors

  • hypertension
  • coronary artery disease
  • congestive heart failure
  • advancing age
  • diabetes mellitus
  • rheumatic valvular disease
  • alcohol abuse
  • male sex
  • presence of other arrhythmias
  • smoking
  • thyroid disease
  • autonomic neuronal dysfunction
  • obesity and obstructive sleep apnea (OSA)
  • caffeine abuse
  • cancer
  • working long hours
  • excessive exercise
  • height

Diagnostic investigations

1st investigations to order

  • ECG
  • thyroid profile
  • echocardiogram
  • serum electrolytes (including serum magnesium) and BUN

Investigations to consider

  • serum aminotransferases
  • prolonged ECG monitoring

Treatment algorithm



Arti N. Shah, MS, MD

Assistant Professor of Medicine

Mount Sinai School of Medicine

New York



ANS declares that she has no competing interests.

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

President, Cardiovascular and Heart Rhythm Consultants

Clinical Professor of Medicine

Icahn School of Medicine at Mount Sinai

Attending and Consultant Cardiac Electrophysiologist

Mount Sinai and New York Presbyterian Hospitals

New York



BKK declares that he has no competing interests.

Peer reviewers

Andrew R.J. Mitchell, BM, MD, FRCP, FESC, FACC

Consultant Cardiologist

Jersey General Hospital

St Helier


Channel Islands


ARJM declares that he has no competing interests.

Diwakar Jain, MD, FACC, FRCP, FASNC

Professor of Medicine (Cardiology)

Westchester Medical Center




DJ declares that he has no competing interests.

Konstadinos Plestis, MD, FACS

Associate Professor

Department of Cardiothoracic Surgery

Mount Sinai Medical Center

New York



KP declares that he has no competing interests.

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