Atrial Fibrillation Differential Diagnoses
- Author: Lawrence Rosenthal, MD, PhD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD more...
The diagnosis of atrial fibrillation is based on the physical finding of an irregular heart rhythm and is confirmed with an ECG or rhythm strip.
When atrial fibrillation is suspected during auscultation of the heart with irregularly irregular beats, obtaining a 12-lead electrocardiography is the next step. Because atrial fibrillation is due to irregular atrial activation at the rate of 350-600 bpm with irregular conduction through the atrioventricular node, it appears on ECG as irregularly irregular narrow complex tachycardia. The F waves may be seen as fibrillatory waves or may be absent. Unless the heart is under excess sympathetic or parasympathetic stimulation, the ventricular rate is usually between 80 and 180 bpm.
With an abnormality in the intraventricular conduction system, the QRS complexes may become wide. It is important to pay attention to the electrocardiographic signs of associated cardiac diseases, such as left ventricular hypertrophy and preexcitation.
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|Risk Factors||Relative Risk|
|Prior stroke or TIA||2.5|
|History of hypertension||1.6|
|Heart failure and/or reduced left ventricular function||1.4|
|Coronary artery disease||1.5|
|CHADS2 Score||Adjusted Stroke Rate (%/y)|
|Risk Category||Recommended Therapy|
|No risk factors||Aspirin 81-325 mg daily|
|One moderate-risk factor||Aspirin 81-325 mg daily or warfarin (INR 2-3)|
|Any high-risk factor or more than 1 moderate-risk factor||Warfarin (INR 2-3)|