Clinical presentation and complications of atrial fibrillation
THE CONTEXT
Atrial fibrillation (AF) may cause symptoms and haemodynamic deterioration or remain unrecognised until an incidental diagnosis or embolic event.
Symptoms and haemodynamic effects
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Typical symptoms are palpitation, breathlessness and fatigue.
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In patients with poor ventricular function or valve disease, loss of atrial function and heart rate control may precipitate or worsen cardiac failure.
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A fall in blood pressure may cause lightheadedness.
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Underlying coronary artery disease may be associated with chest pain, sometimes accompanied by ST segment and T-wave abnormalities on the ECG and troponin elevation.
Silent presentation and embolism
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Older patients may have AF without a rapid ventricular rate or symptoms. Diagnosis may occur incidentally during routine examination or an ECG.
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Asymptomatic AF may present with systemic embolism and is a major cause of stroke in older people.