From the Guidelines
Atrial fibrillation (AFib) symptoms include fatigue, tiredness, exertional shortness of breath, palpitations, and chest pain, which should be evaluated using the modified EHRA symptom scale before and after initiation of treatment, as recommended by the 2024 ESC guidelines 1.
Symptoms of Atrial Fibrillation
The symptoms of AFib can vary from person to person, but common symptoms include:
- Irregular heartbeat or palpitations (feeling like your heart is skipping beats, fluttering, or beating too hard or fast)
- Fatigue
- Shortness of breath
- Chest pain or discomfort
- Dizziness
- Weakness
- Reduced ability to exercise It is essential to note that some people with AFib may not experience any symptoms at all.
Diagnosis and Evaluation
If AFib is suspected, a healthcare provider should be consulted immediately for proper diagnosis. The diagnosis of AFib is typically established by an electrocardiogram (ECG or EKG), which records the heart's electrical activity 1.
Importance of Early Detection
Early detection of AFib is crucial because it increases the risk of stroke due to blood pooling in the heart's chambers, potentially forming clots that can travel to the brain.
Treatment and Management
The treatment and management of AFib may involve medications like blood thinners, rate control medications, or rhythm control medications to reduce complications, as well as lifestyle modifications such as weight loss, physical activity, and reducing alcohol consumption, as recommended by the 2024 ESC guidelines 1. The evaluation of AF-related symptoms is crucial in guiding treatment choices and informing shared decision-making, and should be performed before and after major changes in treatment, as recommended by the 2024 ESC guidelines 1.
From the Research
Symptoms of Atrial Fibrillation (Afib)
- Palpitations
- Exertional dyspnea
- Fatigue
- Chest pain 2
Diagnosis and Treatment
- Diagnosis is based on history and physical examination findings and should be confirmed with 12-lead electrocardiography or other recording device 2
- Many patients with atrial fibrillation are asymptomatic, but symptoms can include the above mentioned 2
- The initial evaluation should include transthoracic echocardiography; serum electrolyte levels; complete blood count; and thyroid, kidney, and liver function tests 2
- Stroke risk should be assessed in patients with atrial fibrillation using the CHA2DS2-VASc score 2, 3, 4
- Warfarin and direct oral anticoagulants reduce the risk of stroke by preventing atrial thrombus formation and subsequent cerebral or systemic emboli 2, 4
- Hemodynamically unstable patients, including those with decompensated heart failure, should be evaluated and treated emergently 2, 3, 4
- Most hemodynamically stable patients should be treated initially with rate control and anticoagulation 2, 3, 4
- Rhythm control, using medications or procedures, should be considered in patients with hemodynamic instability or in some patients based on risk factors and shared decision-making 2, 3, 4
- Electrical cardioversion may be appropriate as first-line rhythm control 2, 4
- Conversion to sinus rhythm with catheter ablation may be considered in patients who are unable or unwilling to take rate or rhythm control medications long-term or if medications have been ineffective 5, 6