Evaluation of Atrial Fibrillation and Clinical Manifestation
Symptoms due to AF are highly variable and depend on several factors including VR, cardia function, concomitant medical problems and individual patient perception. The rapid and irregular rhythm and the loss of synchronized atrial activity both contribute to impaired cardiac performance and symptomaology. While palpitation is the commonest presenting symptoms in over half 54% of patients with AF, a significant proportion of patients may present with other symptoms , including dyspnea 44%, fatigue 14% and dizziness 10%.
Importantly, 11% of patients with AF are asymptomatic. Furthermore, the first clinical presentation of AF may be an embolic complication or aggravation of CHF. A history of alcohol use and athletic predisposition should be sought. On examination, signs of hyperthyroidism and evidence of peripheral embolisation should be evaluated. Underlying valvular disease, hypertension HTN and HF should also be assessed.
There is no single widely accepted classification of AF. However, a clinical classification of AF, based on the temporal pattern of AF occurrence is useful to help the physician in selecting a therapeutic approach. In this classification, the main categories of are new, onset and chronic AF. When AF is documented in a patient for the first it is termed new onset of AF. This can be a transient event due to a reversible cause or may move to paroxysmal terminate spontaneously, usually within 48 hours and recurrent, persistent (sinus rhythm is restored by chemical or electrical cardioversion orpermanent either failed conversion or a low success rate considered by the physician.
Routine blood tests that include thyroid and renal function and diabetic screening are essential. Other acute and reversible causes of AF, such as pulmonary diseases and infection, should be ruled out. If the patient is in AF, a 12-lead ECG should be recorded. This not only documents the rhythm, but also gives an idea of the rate and irregularity, and for possible LV hypertrophy or underlying myocardial infarction.