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&nbsp;<div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|PT 635 Pathophysiology of Complex Patient Problems]] This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox">
<div class="editorbox">'''[[Stroke|Original]] Editors '''- [[Pathophysiology of Complex Patient Problems|Students from Bellarmine University's&nbsp;Pathophysiology of Complex Patient Problems project.]]<br>
'''Original Editors '''- [[Pathophysiology of Complex Patient Problems|Students from Bellarmine University's&nbsp;Pathophysiology of Complex Patient Problems project.]]  
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp; </div>
== Introduction  ==
[[File:Atrial_Fibrillation_TPMJM_BUDPT.png|right|528x528px]]
Atrial fibrillation is the most common type of [[Heart Arrhythmias: Assessment|heart arrhythmia]]. It is due to abnormal electrical activity within the atria of the [[Anatomy of the Human Heart|heart]] causing them to fibrillate. Is characterized as a tachyarrhythmia ie the [[Heart Rate|heart rate]] is often fast. Due to its rhythm irregularity, blood flow through the heart becomes turbulent and has a high chance of forming a thrombus which can dislodge and embolize to the [[Brain Anatomy|brain]] and other parts of the body<ref name=":8">Nesheiwat Z, Jagtap M. [https://www.ncbi.nlm.nih.gov/books/NBK526072/ Rhythm, Atrial Fibrillation (A Fib).] InStatPearls [Internet] 2018 Oct 27. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526072/ (last accessed 11.1.2020)</ref>. 


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp; 
Watch this 1 minute video on AF{{#ev:youtube|pgOHs3NTmIY}}
</div>
== Definition/Description  ==


Atrial fibrillation (AF), is the most common type of arrhythmia During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.<br> <br>AF occurs when rapid disorganized electrical signals cause the heart's two upper chambers- the atria to fibrillate. “Fibrillate" means that the heart muscle is not making full contractions. Instead, the cardiac muscle in the atria is quivering at a rapid and irregular pace. <br> <br>Due to the atrial fibrillations, blood pools in the atria as it is not completely pumped out of the atria into the two lower chambers known as the ventricles.<br> <br>People who have AF may not feel symptoms. In some individuals AF can cause chest pain,(MORE SYMPTOMS FOR THE LAY PERSON HERE)*** heart failure, and can increase the risk of stroke.<sup>1</sup><sup></sup><sup></sup><br>  
== Etiology ==
[[File:RiskFactors.jpg|thumb|471x471px|AF risk factors]]
The risk of developing AF is substantially higher in elderly individuals. Common causes of AF include long-term high blood pressure, coronary heart disease and valvular heart disease. Other risks for AF include obesity, having a thyroid condition, diabetes, chronic kidney disease, obstructive sleep apnoea, and smoking or consuming alcohol excessively. For some people, there is no apparent cause.<ref name=":0">AIHW Atrial fibrillation in Australia Available:https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/atrial-fibrillation-in-australia/contents/what-is-atrial-fibrillation (accessed 3.2.2022)</ref>


<sup></sup>Atrial Fibrillations can occur independently or may be associated with underlying causes. It can manifest itself suddenly as in paroxysmal AF which terminates spontaneously or with intervention within 7 days of onset. AF not associated with an underlying cause is known as lone AF.  
The 3 patterns of atrial fibrillation include:
# Paroxysmal AF: Here the episodes terminate spontaneously within 7 days.
# Persistent AF: The episodes last more than 7 days and often require electrical or pharmacological interventions to terminate the rhythm
# Long-standing persistent AD: rhythm that has persisted for more than 12 months, either because a pharmacological intervention has not been tried or cardioversion has failed.<ref name=":8" />.


AF sustained longer than seven days is known as persistent AF. When it occurs continuously for longer than twelve months it is known as long-standing persistent AF.  
== Epidemiology/Prevalence ==
The prevalence of atrial fibrillation has been increasing worldwide. It is known that the prevalence of atrial fibrillation generally increases with age. At the age of 80, the lifetime risk of developing atrial fibrillation jumps to 22%.<ref name=":3">Atrial Fibrillation Fact Sheet [Internet]. Center for Disease Control and Prevention; 2013 [updated 2015 August 13; cited 2016 April 5] Available from: http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_atrial_fibrillation.htm</ref>


The term permanent AF is used when the patient and clinician make a joint decision to stop further attempts to restore and/or maintain sinus rhythm. Acceptance of AF represents a therapeutic attitude on the part of the patient and clinician rather than an inherent pathophysiological attribute of AF. Acceptance of AF may change as symptoms, efficacy of therapeutic interventions, and patient and clinician preferences evolve
== Pathophysiology ==
 
There are a wide variety of pathophysiology mechanisms that play a role in the development of atrial fibrillation. Most commonly, hypertension, structural, valvular, and ischemic heart disease illicit the paroxysmal and persistent forms of atrial fibrillation but the underlying pathophysiology is not well understood. Some research has shown evidence of genetic causes of atrial fibrillation involving chromosome 10.<ref name=":8" />
Nonvalvular AF is a term used to describe when there is the absence of rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair. <sup>2</sup>
== Clinical Presentation ==
 
[[File:Atrial fib stroke.jpeg|thumb|AF Stoke|alt=]]
== Prevalence  ==
Often, people with AF do not know that they have it, and they do not experience any symptoms. Others may experience an irregular pulse, heart palpitations (‘fluttering’), fatigue, weakness, discomfort, shortness of breath or dizziness.<ref name=":0" />
 
Atrial fibrillation (AF) is a cardiac arrhythmia associated with significant morbidity and mortality, affecting more than 3 million people in the United States and 1-2% of the population worldwide. Its estimated prevalence is expected to double within the next 50 years<br>AF without associated heart disease: Approximately 30% to 45% of cases of paroxysmal AF and 20% to 25% of cases of persistent AF occur in young patients without demonstrable underlying disease. This is considered lone AF. Although, over the course of time, an underlying, causal disease may appear.<sup>3</sup>
 
<sup></sup><br>AF may occur in the elderly without underlying heart disease as well. However changes in cardiac structure and function that accompany the aging process, such as increased myocardial stiffness, may be associated with AF.<sup><span style="font-size: 11px;">4</span></sup>
 
AF with associated heart disease: Specific cardiovascular conditions associated with AF include valvular heart disease (most often mitral valve disease), HF, coronary artery disease (CAD), and hypertension, particularly when LV hypertrophy (LVH) is present. In addition, AF may be associated with HCM, dilated cardiomyopathy, or congenital heart disease, especially atrial septal defect in adults. Potential etiologies also include restrictive cardiomyopathies (e.g., amyloidosis, hemochromatosis, and endomyocardial fibrosis), cardiac tumors, and constrictive pericarditis. Other heart diseases, such as mitral valve prolapse with or without mitral regurgitation, calcification of the mitral annulus, cor pulmonale, and idiopathic dilation of the right atrium, have been associated with a high incidence of atrial fibrillation.<sup>4</sup>
 
Familial associated AF:<br>Familial AF, defined as lone AF running in a family, is more common than previously recognized but should be distinguished from AF secondary to other genetic diseases like familial cardiomyopathies. The likelihood of developing AF is increased among the offspring of parents with AF, suggesting a familial susceptibility to the arrhythmia, but the mechanisms associated with transmission are not necessarily electrical, because the relationship has also been seen in patients with a family history of hypertension, diabetes, or HF.<sup>4</sup>
 
Autonomic Influence in AF:<br>In general, vagally mediated AF occurs at night or after meals, while adrenergically induced AF typically occurs during the daytime. Beta blockers are initial drug of choice for adrenergic dominated AF.<sup><span style="font-size: 11px;">4</span><br></sup><br>
 
== Characteristics/Clinical Presentation ==
 
Symptoms vary on the functional state of the heart, the location of the fibrillation, and may exist without symptoms. The affected individual is usually aware of the irregular heart action and reports feeling “palpitations” or sensations of fluttering, skipping and pounding. Other symptoms experienced can be inadequate blood flow which can cause feelings of dizziness, chest pain, fainting, dyspnea, pallor, fatigue, nervousness, and cyanosis. More than six palpitations occurring in a minute or prolonged repeated palpitations should be reported to the physician.<sup>5</sup><sup></sup><sup></sup><br><br>
 
Over time, palpitation may disappear as the arrhythmia becomes permanent, it may become asymptomatic- this is particularly common among the elderly. Some patients experience symptoms only during paroxysmal AF, or only intermittently during sustained AF. <br>An initial appearance of AF may be caused by an embolic complication or an exacerbation of HF. Most patients complain of palpitations, chest pain, dyspnea, fatigue, lightheadedness, or syncope. Further, frequent urination (Polyuria) may be associated with the release of atrial natriuretic peptide, particularly as episodes of AF begin or terminate. AF associated with a sustained, rapid ventricular response can lead to tachycardia-mediated cardiomyopathy, especially in patients unaware of the arrhythmia. Syncope is an uncommon complication that can occur upon conversion in patients with sinus node dysfunction or because of rapid ventricular rates in patients with HCM, valvular aortic stenosis, or an accessory pathway.<sup>4</sup>
 
<sup></sup>Patient may or may not have symptoms with AF. Commonly associated symptoms include palpitations, shortness of breath, fatigue, decreasing exercise tolerance, or chest discomfort. An irregular pulse should raise the suspicion for AF. Patients may present initially with TIA or ischemic stroke. Most patients experience asymptomatic episodes of arrhythmias before being diagnosed. Patients with mitral valve disease and heart failure often have higher incidence of AF. Intermittent episodes of AF may progress in duration and frequency and over time many patients will develop sustained AF. For a newly diagnosed patient of AF, reversible causes such as pulmonary embolism, hyperthyroidism, pericarditis and MI should be investigated.<sup>6</sup>
 
 
 
<sup></sup>Pathophysiology <br>Atrial factors: Any kind of structural heart disease may trigger remodeling of both the atria and ventricles. Structural remodeling such as atrial fibrosis and loss of atrial muscle mass are the most frequent histopathological changes in AF which facilitates initiation and perpetuation of AF. Electrical remodeling occurs, resulting in multiple reentry circuits or rapidly firing atrial foci and shortening of atrial refractoriness and action potential, thus contributing to the maintenance of AF. Electrophysiological mechanisms: Focal mechanisms of triggered activity and re-entry have attracted much attention recently. Wavelet Hypothesis suggests several independent wavelets propagating AF rather than a single focus.Familial component should be investigated with early onset AF. AF reduces left atrial flow velocities and causes delayed emptying from atrial appendage and are implicated in thrombus formation.<sup>6, 7</sup><br>Prolonged AF makes restoration and maintenance of sinus rhythm more difficult.<sup>7</sup><br>


== Associated Co-morbidities  ==
== Associated Co-morbidities  ==
These include, but not limited to:; [[Stroke]]; [[Obesity]]; [[Sleep Apnea-Hypopnea Syndrome|Obstructive sleep apnea]]; [[Diabetes]]; [[Heart Failure|Congestive Heart Failure]]; [[Cardiac Valve Defects|Mitral valve disease]]; [[Coronary Artery|Coronary artery disease]] <ref name=":1">Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol. 2006: 114(7): p. 257-354.</ref><ref name=":4">Goodman CC, Snyder TE. Differential Diagnosis for Physical Therapists, Screening for Referral. 5th ed. St. Louis Saunders; 2012. p. 264-266.</ref><ref name=":5">Wadke R. Atrial Fibrillation. Disease-a-Month. 2013 March: 59(3): 67-73.</ref><ref name=":6">Oishi ML, Xing S. Atrial fibrillation: Management strategies in the emergency department. Emerg Med Prac. 2013: 15(2): p. 1-26.</ref><ref name=":7">Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J Kara T, Somers VK. Obstructive Sleep Apnea, Obesity, and the Risk of Incident Atrial Fibrillation. J Am Coll Cardiol [Internet]. 2007 Feb [cited 2016 April 9]; 49(5): 565-571. Available from: http://content.onlinejacc.org/article.aspx?articleid=1188673&amp;...#tab1</ref>


Obesity - Obesity and the magnitude of nocturnal oxygen desaturation, which is an important pathophysiological consequence of OSA, are independent risk factors for incident AF in individuals &lt;65 years of age.<sup>8</sup><br>Obesity is an important risk factor for the development of AF (103). After adjustment for clinical risk factors, the excess risk of AF appears related to LA dilation. There is a graded increase in LA size as body mass index increases from normal to the overweight and obese categories, and weight has been linked to regression of LA enlargement (104). These findings suggest a physiological link between obesity, AF, and stroke and raise the intriguing possibility that weight reduction may decrease the risk associated with AF.<sup>4</sup><br>Diabetes<br>May cause CHF<br>Mitral valve disease<br>Heart failure<br>Coronary artery disease<br>Hypertension associated with left ventricular hypertrophy<br>Hypertrophic obstructive cardiomyopathy<br>Dilated cardiomyopathy<br>Atrial septal defect<br>A persistently elevated ventricular rate during AF (usually &gt; 120 beats/min) for prolonged time periods may also result in increased mitral regurgitation, eventually leading to a dilated ventricular cardiomyopathy (tachycardia-induced cardiomyopathy).<sup>7</sup><br><br>
Stroke can occur during atrial fibrillation. A blood clot forms in the left atrium of the heart, a piece of the clot breaks off and travels to an artery in the brain. See illustration.
 
== Diagnosis ==
== Medications  ==
Atrial fibrillation is usually diagnosed using an [[electrocardiogram]] (ECG). Other tests include: 24-hour heart  holter monitor; Cardiogram (heart ultrasound); [[Blood Tests|Blood test]]; Stress tests; [[Six Minute Walk Test / 6 Minute Walk Test|6 minute walk test]]; Physical Exam: Irregular [[Heart Rate|heart rate]], irregular jugular venous pulsations, variation in the intensity of first heart sound.<ref name=":1" /><ref name=":2">Amerena JV, Walters TE, Mirzaee S, Kalman JM. Update on the management of atrial fibrillation. Med J Aust. 2013: 199(9): p. 592-7.</ref><ref name=":4" /><ref name=":5" />
 
Rate control*<br>Beta Blocker<br>Metoprolol CR/XL(Toprol XL)<br>Bisoprolol (Zebeta)<br>Atenolol (Tenormin)<br>Esmolol (Brevibloc)<br>Propranolol (Inderal)<br>Carvedilol (Coreg)<br>Antihypertensive and calcium channel blocker<br>Verapamil (Calan)<br>Diltiazem (Cardizem)<br>Antiarrhythmic and blood pressure support<br>Digoxin (Lanoxin) <br>Antiarrhythmic<br>Amiodarone (Cordarone) <br>Dronedarone (Multaq)
 
Rhythm control (Antiarrhythmics)<br>Amiodarone(Cordarone)<br>Flecainide (Tambocor)<br>Propafenone(Rythmol)<br>Sotalol(Betapace)
 
Meds such as anticoagulants can cause brain hemorrhage. Benefits must be closely monitored. <sup>6</sup><br>
 
== Diagnostic Tests/Lab Tests/Lab Values  ==
 
12 lead EKG<sup>6</sup><br> Several characteristic electrocardiogram (ECG) changes define AF: 1. Presence of low-amplitude fibrillatory waves on ECG without defined P-waves 2. Irregularly irregular ventricular rhythm 3. Fibrillatory waves typically have a rate of &gt; 300 beats per minute 4. Ventricular rate is typically between 100 and 160 beats per minute. <sup>7</sup><br>Holter monitor<sup>6</sup><br>Event recorder<sup>6</sup><br>Blood test<sup>6</sup><br>Stress tests<sup>6</sup><br>Chest X-ray<sup>6</sup><br>LV Hypertrophy<sup>4</sup><br>6 minute walk test<sup>4</sup><br>Physical Exam: Irregular pulse, irregular jugular venous pulsations, variation in intensity of first heart sound.<sup>4</sup><br><br>
 
== Etiology/Causes  ==
 
AF is a common early postoperative complication of cardiac and thoracic surgery. (other sources (Surgery (intrathoracic) - common as an early post op complication of thoracic surgery including cardiac surgery. )<br>Alcohol use (Holiday syndrome)<br>Caffeine*<br>High fevers*severe infection/ pneumonia<br>Presence of helicobacter pylori in stomach is associated with persistent AF*<br>Emotional stress* BOOK
 
MI<br>Pericarditis/pericardial disease/myocarditis <br>Pulmonary Embolism<br>Electrocution<br>Hyperthyroidism (up to 15% of hyperthyroidism pts)<br>Kidney dis/ electrolyte abnormalities/Other metabolic<br>Increasing age<br>Male &gt; Female (source 8 also)<br>mitral valve disease, <br>conduction system disorders, Wolff-Parkinson-White syndrome, <br>Conditions associated with AF:<br>thyrotoxicosis, hypothermia, hypoxia,<br>Digoxin toxicity<br>Lone AF applies to AF in individuals younger than 60 years of age without clinical or echocardiographic evidence of cardiopulmonary disease (including hypertension), Lone AF is favorable in regard to statistics of thromboembolism and mortality.<sup>4,5,6,7,8</sup><br>


== Systemic Involvement  ==
== Systemic Involvement  ==


High concentrations of CRP, which confirm the presence of systemic inflammation are present in people with AF. A potential non-cardiovascular disease that predisposes individuals to AF may be chronic gastritis caused by chronic H. pylori infection.<sup>4 &nbsp;</sup>&nbsp;<br>WE NEED MORE INFO HERE ?
High concentrations of CRP in the [[Blood Tests|blood test]], which confirm the presence of systemic [[Inflammation Acute and Chronic|inflammation]] are present in people with Atrial Fibrillation (AF).<ref name=":1" />  


== Medical Management (current best evidence)  ==
Changes in an individual's health such as a newly diagnosed complication may have a psychological impact. Patients may experience [[depression]] and other psycho-social challenges as a result of changes in their health status, treatment, frequent visits to the physician's office, and fear of the unknown that may accompany a diagnosis of atrial fibrillation.


Rate control and rhythm control through medications<br>Catheter ablation<br>Atrioventricular node ablation<br>Surgical maze procedure<br>Studies have demonstrated that a rate control strategy, with a target resting heart rate between 80 and 100 beats/minute, is recommended over rhythm control in the vast majority of patients. add text here<br>Thromboembolism Prevention<sup>3,4,6</sup>
== Management ==
[[File:Cardioversion.png|thumb|Cardioversion]]
Treatment strategy in recently diagnosed cases of atrial fibrillation includes identification and solution of reversible risk factors with anticoagulation therapy followed by [[Beta-blockers in the Treatment of Hypertension|beta-blockers]].<ref>Radiopedia AF Available: https://radiopaedia.org/articles/atrial-fibrillation?lang=us<nowiki/>(accessed 3,3.2022)</ref>  


== Physical Therapy Management (current best evidence) ==
Non-pharmacological therapy includes ablation therapy, a hospital procedure which inactivates small areas of tissue in the heart responsible for the abnormal electrical signals associated with AF.  [[Cardiac Implantable Electronic Devices (CIEDs)|Pacemaker placement]] is considered in severe causes resulting in heart failure in atrial fibrillation<ref name=":8" />.


add text here
People with prolonged or severe AF may undergo [[cardioversion]]. Pharmacological cardioversion uses medicines to achieve the same purpose. After cardioversion, long-term medicines are often prescribed to help prevent AF from reoccurring<ref name=":0" />.


== Differential Diagnosis  ==
== Physical Therapy Management  ==


add text here
There is limited research on the effect of traditional physical therapy and Atrial Fibrillation.&nbsp;<br>There is also conflicting information on the use of exercise to reduce the risk of AF. &nbsp;Since obesity is an important risk factor, management of weight through exercise and education is a crucial, proactive measure that may reduce the incidence of AF. However, there is conflicting evidence in regard to the optimal prescription of exercise.&nbsp;


== Case Reports/ Case Studies  ==
== Case Reports ==


add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>
Ezekowitz MD, Aikens TH, Nagarakanti R, Shapiro T. [http://circ.ahajournals.org/content/124/1/95.full#cited-by Atrial fibrillation: outpatient presentation and management]. Circulation. 2011; 124: 95–99. Available from: American Heart Association.<br>.


== Resources <br> ==
== Resources   ==
 
* <u></u>AFIB matters: [http://www.afibmatters.org/Living-with-atrial-fibrillation Atrial Fibrillation]
add appropriate resources here
* American Heart Association:&nbsp;[http://www.heart.org/HEARTORG/Conditions/Arrhythmia/AboutArrhythmia/AFib-Resources-For-Patients-Professionals_UCM_423786_Article.jsp#.Vww-X4S9jzI Atrial Fibrillation Resources For Patients &amp; Professionals]
 
* Cleveland Clinic:&nbsp;[http://www.clevelandclinic.org/lp/atrial_fibrillation/index.html?searchdef=21076362156527&002=2107636&006=89400250002&007=Search&008=&009=b&012=a%20fib&021=26286861794902&025=c&026=&utm_campaign=CS+-+Heart+-+DR+-+Afib+Local&utm_medium=cpc&utm_source=google_ppc&utm_term=a+fib&utm_content=89400250002&k_clickid=d4933b79-9aaf-4351-b2b0-eab57ffb625b&gclid=CjwKEAjw86e4BRCnzuWGlpjLoUcSJACaHG55gPkgoyxTsODA4sc2FaTx-j9dd0P8TON9Rr-8A1OWBRoCCr3w_wcB&k_clickid=d4933b79-9aaf-4351-b2b0-eab57ffb625b Advanced Treatment for Atrial Fibrillation]
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
* Mayo Clinic: [http://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/atrial-fibrillation-care-at-mayo-clinic/ovc-20164979 Atrial Fibrillation]
 
* StopAfib.org: [http://www.stopafib.org/resources.cfm Atrial Fibrillation Resources]
see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
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<rss>addfeedhere|charset=UTF-8|short|max=10</rss>
</div>


== References  ==
== References  ==


see [[Adding References|adding references tutorial]].
[[Category:Bellarmine_Student_Project]]
 
[[Category:Medical]]
[[Category:Acute Care]]
[[Category:Cardiopulmonary]]
[[Category:Cardiovascular Disease - Conditions]]
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[[Category:Bellarmine_Student_Project]]

Latest revision as of 06:42, 3 March 2022

Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Paul McDermott, James Moore, Lucinda hampton, Kim Jackson, Adam Vallely Farrell, Karen Wilson, Vidya Acharya, Elaine Lonnemann, George Prudden and WikiSysop  

Introduction[edit | edit source]

Atrial Fibrillation TPMJM BUDPT.png

Atrial fibrillation is the most common type of heart arrhythmia. It is due to abnormal electrical activity within the atria of the heart causing them to fibrillate. Is characterized as a tachyarrhythmia ie the heart rate is often fast. Due to its rhythm irregularity, blood flow through the heart becomes turbulent and has a high chance of forming a thrombus which can dislodge and embolize to the brain and other parts of the body[1]. 

Watch this 1 minute video on AF

Etiology[edit | edit source]

AF risk factors

The risk of developing AF is substantially higher in elderly individuals. Common causes of AF include long-term high blood pressure, coronary heart disease and valvular heart disease. Other risks for AF include obesity, having a thyroid condition, diabetes, chronic kidney disease, obstructive sleep apnoea, and smoking or consuming alcohol excessively. For some people, there is no apparent cause.[2]

The 3 patterns of atrial fibrillation include:

  1. Paroxysmal AF: Here the episodes terminate spontaneously within 7 days.
  2. Persistent AF: The episodes last more than 7 days and often require electrical or pharmacological interventions to terminate the rhythm
  3. Long-standing persistent AD: rhythm that has persisted for more than 12 months, either because a pharmacological intervention has not been tried or cardioversion has failed.[1].

Epidemiology/Prevalence[edit | edit source]

The prevalence of atrial fibrillation has been increasing worldwide. It is known that the prevalence of atrial fibrillation generally increases with age. At the age of 80, the lifetime risk of developing atrial fibrillation jumps to 22%.[3]

Pathophysiology[edit | edit source]

There are a wide variety of pathophysiology mechanisms that play a role in the development of atrial fibrillation. Most commonly, hypertension, structural, valvular, and ischemic heart disease illicit the paroxysmal and persistent forms of atrial fibrillation but the underlying pathophysiology is not well understood. Some research has shown evidence of genetic causes of atrial fibrillation involving chromosome 10.[1]

Clinical Presentation[edit | edit source]

AF Stoke

Often, people with AF do not know that they have it, and they do not experience any symptoms. Others may experience an irregular pulse, heart palpitations (‘fluttering’), fatigue, weakness, discomfort, shortness of breath or dizziness.[2]

Associated Co-morbidities[edit | edit source]

These include, but not limited to:; Stroke; Obesity; Obstructive sleep apnea; Diabetes; Congestive Heart Failure; Mitral valve disease; Coronary artery disease [4][5][6][7][8]

Stroke can occur during atrial fibrillation. A blood clot forms in the left atrium of the heart, a piece of the clot breaks off and travels to an artery in the brain. See illustration.

Diagnosis[edit | edit source]

Atrial fibrillation is usually diagnosed using an electrocardiogram (ECG). Other tests include: 24-hour heart holter monitor; Cardiogram (heart ultrasound); Blood test; Stress tests; 6 minute walk test; Physical Exam: Irregular heart rate, irregular jugular venous pulsations, variation in the intensity of first heart sound.[4][9][5][6]

Systemic Involvement[edit | edit source]

High concentrations of CRP in the blood test, which confirm the presence of systemic inflammation are present in people with Atrial Fibrillation (AF).[4]

Changes in an individual's health such as a newly diagnosed complication may have a psychological impact. Patients may experience depression and other psycho-social challenges as a result of changes in their health status, treatment, frequent visits to the physician's office, and fear of the unknown that may accompany a diagnosis of atrial fibrillation.

Management[edit | edit source]

Cardioversion

Treatment strategy in recently diagnosed cases of atrial fibrillation includes identification and solution of reversible risk factors with anticoagulation therapy followed by beta-blockers.[10]

Non-pharmacological therapy includes ablation therapy, a hospital procedure which inactivates small areas of tissue in the heart responsible for the abnormal electrical signals associated with AF. Pacemaker placement is considered in severe causes resulting in heart failure in atrial fibrillation[1].

People with prolonged or severe AF may undergo cardioversion. Pharmacological cardioversion uses medicines to achieve the same purpose. After cardioversion, long-term medicines are often prescribed to help prevent AF from reoccurring[2].

Physical Therapy Management[edit | edit source]

There is limited research on the effect of traditional physical therapy and Atrial Fibrillation. 
There is also conflicting information on the use of exercise to reduce the risk of AF.  Since obesity is an important risk factor, management of weight through exercise and education is a crucial, proactive measure that may reduce the incidence of AF. However, there is conflicting evidence in regard to the optimal prescription of exercise. 

Case Reports[edit | edit source]

Ezekowitz MD, Aikens TH, Nagarakanti R, Shapiro T. Atrial fibrillation: outpatient presentation and management. Circulation. 2011; 124: 95–99. Available from: American Heart Association.
.

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 Nesheiwat Z, Jagtap M. Rhythm, Atrial Fibrillation (A Fib). InStatPearls [Internet] 2018 Oct 27. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526072/ (last accessed 11.1.2020)
  2. ↑ 2.0 2.1 2.2 AIHW Atrial fibrillation in Australia Available:https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/atrial-fibrillation-in-australia/contents/what-is-atrial-fibrillation (accessed 3.2.2022)
  3. ↑ Atrial Fibrillation Fact Sheet [Internet]. Center for Disease Control and Prevention; 2013 [updated 2015 August 13; cited 2016 April 5] Available from: http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_atrial_fibrillation.htm
  4. ↑ 4.0 4.1 4.2 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am Coll Cardiol. 2006: 114(7): p. 257-354.
  5. ↑ 5.0 5.1 Goodman CC, Snyder TE. Differential Diagnosis for Physical Therapists, Screening for Referral. 5th ed. St. Louis Saunders; 2012. p. 264-266.
  6. ↑ 6.0 6.1 Wadke R. Atrial Fibrillation. Disease-a-Month. 2013 March: 59(3): 67-73.
  7. ↑ Oishi ML, Xing S. Atrial fibrillation: Management strategies in the emergency department. Emerg Med Prac. 2013: 15(2): p. 1-26.
  8. ↑ Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J Kara T, Somers VK. Obstructive Sleep Apnea, Obesity, and the Risk of Incident Atrial Fibrillation. J Am Coll Cardiol [Internet]. 2007 Feb [cited 2016 April 9]; 49(5): 565-571. Available from: http://content.onlinejacc.org/article.aspx?articleid=1188673&...#tab1
  9. ↑ Amerena JV, Walters TE, Mirzaee S, Kalman JM. Update on the management of atrial fibrillation. Med J Aust. 2013: 199(9): p. 592-7.
  10. ↑ Radiopedia AF Available: https://radiopaedia.org/articles/atrial-fibrillation?lang=us(accessed 3,3.2022)
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