Hello, welcome everybody, this is Doctor Bolad. Today I will talk to you about
how to diagnose atrial fibrillation. For those who are new to my channel,
I am a board-certified cardiologist and interventional cardiologist,
and here on this channel you will find lots of education about heart health and heart disease,
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about how to diagnose atrial fibrillation. In any patient with suspected or proven
atrial fibrillation, the history from the patient is very important,
and we particularly concentrate on the presence of associated conditions that increase the risk
of development of atrial fibrillation. These conditions include other cardiovascular disease,
cerebrovascular disease, diabetes, high blood pressure, chronic obstructive pulmonary disease
and obstructive sleep apnea. In addition, we ask about symptoms of overactive thyroid
and whether the individual uses excessive alcohol. All these conditions I mentioned
are associated with increased risk of development of atrial fibrillation.
During physical examination we focus on the cardiovascular system and any associated
conditions. abnormal findings may provide information to the physician about associated
conditions that might be contributing to the onset of atrial fibrillation. These include heart
murmurs or arterial pulse abnormalities that might indicate narrowed or leaky mitral or aortic valve,
hypertrophic cardiomyopathy, and signs and symptoms of heart failure.
During atrial fibrillation with an irregularly irregular pulse, there is commonly a slight
variation in the intensity of the heart sounds. As the heart rate is irregular and fast,
some heart ventricular contractions will occur when the heart ventricles are under-filled. This
results in ventricular beats with insufficient low volume to transmit the pressure wave to the arm.
variation in cuff blood pressure readings is also common during atrial fibrillation due to changes
in the beat-to-beat contraction and changes in left ventricular filling and ejection volume.
It is often necessary to measure the blood pressure multiple times
and average these values to obtain a more accurate blood pressure reading.
For all patients with suspected new-onset atrial fibrillation, a 12-lead electrocardiogram,
also known as 12 lead ECG or EKG, is obtained. On the ECG of atrial fibrillation,
there are no discrete atrial contraction as evidenced by p waves, but there are rapid,
low-amplitude, continuously varying fibrillatory waves as shown by the blue arrows here. The
ventricular rhythm is generally irregularly irregular, lacking a repetitive pattern.
the baseline ecg, should also be evaluated for:
●markers of nonelectrical cardiac disease, such as left ventricular hypertrophy (reflecting
possible high blood pressure) or q-waves (indicating coronary artery disease).
●markers of other electrical heart disease, such as bundle branch block.
●evidence of slow heart rate or sinus node dysfunction
A transthoracic echocardiogram is needed even if the physical examination is otherwise normal.
The echocardiogram does not need to be performed at the time of the first visit in
stable patients. we obtain an echocardiogram in order to evaluate the size of the right
and left atria and the size and contraction function of the right and left ventricles,
to detect possible valvular heart disease, left ventricular hypertrophy, diastolic dysfunction,
and pericardial disease, and to assess peak right ventricular and right atrial pressures.
The echocardiogram may also identify left atrial thrombus, although the sensitivity
is low. Transesophageal echocardiography is much more sensitive for identifying clots in
the left atrium or left atrial appendage and can be used to determine the need for
anticoagulation prior to any attempt at pharmacologic or electrical cardioversion.
Generally, we refer patients with signs or symptoms of ischemic heart disease for exercise
stress testing. Exercise testing is useful to help guide medication therapy for atrial fibrillation,
as some medications are contraindicated in patients with coronary artery disease.
ambulatory cardiac monitoring with event recorders, adhesive event monitors, or insertable
cardiac monitors, also referred to as implantable cardiac monitors or implantable loop recorders,
can be used to identify the arrhythmia if it is intermittent and not captured on routine ecg.
ambulatory ecg monitoring can also be utilized to correlate symptoms to the arrhythmia along
with assessment of the atrial fibrillation burden. twenty-four to forty-eight hour Holter
monitoring mainly aids in the evaluation of overall ventricular response rates in
individuals where a rate control strategy has been chosen and there is concern for inadequate
heart rate control or bradycardia. to get detailed information about heart monitors in heart disease,
you can review my video titled “heart monitors”, available in this channel. I will
leave the link in the video description below. We also obtain laboratory testing in patients with
atrial fibrillation. We obtain complete blood count and kidney function test as baseline in
patients with atrial fibrillation. We also obtain thyroid function test, as clinical or subclinical
overactive thyroid is present in less than 5 percent of patients with atrial fibrillation.
In addition, we also obtain a chest x-ray and this may be a useful diagnostic test in selected
patients with evidence of shortness of breath and potential heart failure or risk of pneumonia.
In subsequent videos, I will talk about how to treat atrial fibrillation.
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This is Doctor Bolad, helping you with your heart health, thanks for watching, and talk to you soon.