Atrial fibrillation physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Anahita Deylamsalehi, M.D.[2]
Overview
Some physical examination findings of atrial fibrillation include irregularly irregular pulse, possible high blood pressure, and other sign of congestive heart failure. The hemodynamic stability of the patient should be first assessed. The patient should also be examined for the presence of reversible causes of atrial fibrillation. A study of routine pulse checks during routine office visits, found that the annual rate of atrial fibrillation diagnosis in elderly patients altered from 1.04% to 1.63%. This implies that routine examination has 64% (1.04/1.63) sensitivity and should be done regularly. Thyroid exmaination should be considered, specially in younger patients with atrial fibrillation. In patients with dyspnea, tachypnea could be detected and a finding such as rales would suggest heart failure.
Physical Examination
Appearance of the Patient
- Patients with atrial fibrillation usually appear normal.
Vital Signs
The following are some common vital sign findings in patients with atrial fibrillation (AF):[1][2][3]
- Pulse:
- In the setting of drug toxicity or hypothermia, the pulse may be slower.
- The pulse is irregularly irregular. In general the heart rate is 100-140 beats per minute.
- In the presence of atrial fibrillation the pulse could be 150-170 beats per minute (rare).
- Blood pressure:
- The blood pressure should be checked as hypertension is one of the leading causes of atrial fibrillation.
- Narrow pulse pressure (when systolic blood pressure minus diastolic blood pressure is < 25 mm Hg) usually suggest congestive heart failure.
- Respiratory rate:
Skin
- Skin examination of patients with atrial fibrillation is usually normal.
HEENT
- Exopthalmos may suggest hyperthyroidism.[2]
- Retinal hemorrhage may be seen in malignant hypertension
Neck
- The patient should be examined for the presence of thyroid abnormalities.
- Jugular venous distension could be seen in concurrent hypertension or heart failure.
Lung
- Rales would suggest heart failure.
Heart
- The patient should be examined to assess for the presence of congestive heart failure or hypertrophic obstructive cardiomyopathy.
- S3 and S4 would suggest heart failure.
- Heart murmurs and their intensity during postural changes can identify different valvular heart diseases.
Abdomen
- Abdominal examination of patients with atrial fibrillation is usually normal.
Back
- Back examination of patients with atrial fibrillation is usually normal.
Genitourinary
- Genitourinary examination of patients with atrial fibrillation is usually normal.
Neuromuscular
- Neuromuscular examination of patients with atrial fibrillation is usually normal.
Extremities
- Lower leg edema may suggest cardiac failure.
References
- ↑ Perry M, Kemmis Betty S, Downes N, Andrews N, Mackenzie S, Guideline Committee (2021). "Atrial fibrillation: diagnosis and management-summary of NICE guidance". BMJ. 373: n1150. doi:10.1136/bmj.n1150. PMID 34020968 Check
|pmid=value (help). - ↑ 2.0 2.1 Fitzmaurice DA, Hobbs FD, Jowett S; et al. (2007). "Screening versus routine practice in detection of atrial fibrillation in patients aged 65 or over: cluster randomised controlled trial". doi:10.1136/bmj.39280.660567.55. PMID 17673732.
- ↑ Heppell RM, Berkin KE, McLenachan JM, Davies JA (1997). "Haemostatic and haemodynamic abnormalities associated with left atrial thrombosis in non-rheumatic atrial fibrillation". Heart. 77 (5): 407–11. doi:10.1136/hrt.77.5.407. PMC 484760. PMID 9196408.