Fast Five Quiz: Key Aspects of Atrial Fibrillation

Yasmine S. Ali, MD

Disclosures

September 13, 2018

Physical examination always begins with airway, breathing, and circulation (ABCs), and vital signs, as these guide the pace of the intervention. The physical examination also provides information on underlying causes and sequelae of AF. Examination of the head and neck may reveal exophthalmos, thyromegaly, elevated jugular venous pressures, or cyanosis. Carotid artery bruits suggest peripheral arterial disease and increase the likelihood of comorbid coronary artery disease.

As many as 90% of AF episodes are not associated with symptoms. However, many patients experience a wide variety of symptoms, including palpitations, dyspnea, fatigue, dizziness, angina, and decompensated heart failure. In addition, AF can be associated with hemodynamic dysfunction, tachycardia-induced cardiomyopathy, and systemic thromboembolism.

Patients with AF have an irregularly irregular pulse and are commonly tachycardic, with heart rates typically 110-140 beats/min but rarely over 160-170 beats/min. Patients who are hypothermic or who have cardiac drug toxicity may present with bradycardic atrial fibrillation.

The cardiac examination is central to the physical examination of the patient with AF. Thorough palpation and auscultation are necessary to evaluate for valvular heart disease or cardiomyopathy. A displaced point of maximal impulse or S3 suggests ventricular enlargement and elevated LV pressure. A prominent P2 points to the presence of pulmonary hypertension.

For more on the presentation of AF, read here.

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