Atrial fibrillation history and symptoms

Overview
Approximately 90% of episodes of atrial fibrillation are asymptomatic. Indeed, it is not uncommon to identify atrial fibrillation on a routine physical examination or electrocardiogram (ECG/EKG), as it may be asymptomatic in many cases. The section below describes the constellation of symptoms (usually palpitations and exercise intolerance) when they do occur.

History
It is important to gather the following information from the patient:
 * The presence and nature of symptoms if any associated with AF. Patients can be grouped into two broad classes:
 * Those who are entirely asymptomatic when they are in atrial fibrillation (in which case the atrial fibrillation is found as an incidental finding on an electrocardiogram or physical examination)
 * Those who have clear symptoms and can pinpoint the time at which an episode of atrial fibrillation begins and when they revert to normal sinus rhythm.


 * The clinical type of AF (first episode, paroxysmal, persistent, or permanent)
 * The onset of the first symptomatic attack or date of discovery of AF
 * The frequency, duration, precipitating factors, and modes of termination (e.g vagal maeuvers) of AF
 * The response to any pharmacological agents that have been administered or history of ablation
 * The presence of any underlying heart disease or other reversible conditions (e.g., hypertension, recent CABG,hyperthyroidism or alcohol consumption)

Symptoms
When symptoms are present, they often include symptoms related to the rapid heart rate:
 * Palpitations
 * Exercise intolerance due to the rapid heart rate
 * Fatigue
 * Lightheadedness

More serious symptoms include the following:
 * Chest pain if there is underlying atherosclerosis
 * Dyspnea, shortness of breath and edema if congestive heart failure is present
 * Syncope: Syncope is an uncommon but serious complication that is usually associated with sinus node dysfunction or hemodynamic obstruction, such as valvular aortic stenosis, HCM, cerebrovascular disease, or an accessory AV pathway.
 * TIA or stroke: Sometimes the arrhythmia will be identified only with the onset of a stroke or a transient ischemic attack (TIA, stroke symptoms resolving within 24 hours).