Summary
Definition
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
paroxysmal or persistent AF: hemodynamically unstable
paroxysmal or persistent AF: hemodynamically stable
permanent AF
Contributors
Authors
Arti N. Shah, MS, MD
Assistant Professor of Medicine
Mount Sinai School of Medicine
New York
NY
Disclosures
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
NY
Disclosures
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
Jersey
Channel Islands
Disclosures
ARJM declares that he has no competing interests.
Diwakar Jain, MD, FACC, FRCP, FASNC
Professor of Medicine (Cardiology)
Westchester Medical Center
Valhalla
NY
Disclosures
DJ declares that he has no competing interests.
Konstadinos Plestis, MD, FACS
Associate Professor
Department of Cardiothoracic Surgery
Mount Sinai Medical Center
New York
NY
Disclosures
KP declares that he has no competing interests.
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- Atrial flutter with variable atrioventricular (AV) conduction
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