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Diagnostic Testing in the Emergency Department of Atrial Fibrillation

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Short Stay Management of Atrial Fibrillation

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

Workup of atrial fibrillation starts with a thorough history and physical exam. Physical exam should focus on heart sounds, an irregular pulse, and signs of heart failure. Diagnosis of atrial fibrillation is by electrocardiogram showing the absence of P waves and an irregularly irregular rhythm. Laboratory testing includes electrolytes and kidney function, hemoglobin, thyroid function, brain natriuretic peptide, and cardiac enzymes. A chest radiograph can help diagnose gross thoracic or cardiac abnormalities and the presence of heart failure. Lastly, echocardiography is important in evaluating structural cardiac defects and also the presence of blood clots in the atrium or atrial appendages.

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References

  1. Rich MW. Epidemiology of atrial fibrillation. J Interv Card Electrophysiol. 2009;25(1):3–8. Epub 2009 Jan 22.

    Article  PubMed  Google Scholar 

  2. Mandyam MC, Vedantham V, Scheinman MM, Tseng ZH, Badhwar N, Lee BK, Lee RJ, Gerstenfeld EP, Olgin JE, Marcus GM. Alcohol and vagal tone as triggers for paroxysmal atrial fibrillation. Am J Cardiol. 2012;110(3):364–8. Epub 2012 Apr 20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Lampert R, Jamner L, Burg M, Dziura J, Brandt C, Liu H, Li F, Donovan T, Soufer R. Triggering of symptomatic atrial fibrillation by negative emotion. J Am Coll Cardiol. 2014;64(14):1533–4. doi:10.1016/j.jacc.2014.07.959.

    Article  PubMed  Google Scholar 

  4. Myrstad M, Nystad W, Graff-Iversen S, Thelle DS, Stigum H, Aarønæs M, Ranhoff AH. Effect of years of endurance exercise on risk of atrial fibrillation and atrial flutter. Am J Cardiol. 2014;114(8):1229–33. doi:10.1016/j.amjcard.2014.07.047. Epub 2014 Jul 30.

    Article  PubMed  Google Scholar 

  5. Konecny T, Park JY, Somers KR, Konecny D, Orban M, Soucek F, Parker KO, Scanlon PD, Asirvatham SJ, Brady PA, Rihal CS. Relation of chronic obstructive pulmonary disease to atrial and ventricular arrhythmias. Am J Cardiol. 2014;114(2):272–7.

    Article  PubMed  Google Scholar 

  6. Brembilla-Perrot B, Popescu I, Huttin O, Zinzius PY, Muresan L, Jarmouni S, Nossier I, Schwartz J, Sellal JM, Beurrier D, Andronache M, de Chillou C, Selton O, Louis P, Terrier de la Chaise A. Risk of atrial fibrillation according to the initial presentation of a preexcitation syndrome. Int J Cardiol. 2012;157(3):359–63. doi:10.1016/j.ijcard.2010.12.078. Epub 2011 Jan 15.

    Article  PubMed  Google Scholar 

  7. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland Jr JC, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):2071–104. Epub 2014 Mar 28.

    Article  PubMed  Google Scholar 

  8. Chatterjee S, Bavishi C, Sardar P, Agarwal V, Krishnamoorthy P, Grodzicki T, Messerli FH. Meta-analysis of left ventricular hypertrophy and sustained arrhythmias. Am J Cardiol. 2014;114(7):1049–52. doi:10.1016/j.amjcard.2014.07.015. Epub 2014 Jul 18. Review.

    Article  PubMed  Google Scholar 

  9. Gladstone DJ, Dorian P, Spring M, Panzov V, Mamdani M, Healey JS. Thorpe KE; EMBRACE Steering Committee and Investigators; EMBRACE Steering Committee or Operations Committee. Atrial premature beats predict atrial fibrillation in cryptogenic stroke: results from the EMBRACE trial. Stroke. 2015;46(4):936–41. doi:10.1161/STROKEAHA.115.008714. Epub 2015 Feb 19.

    Article  PubMed  Google Scholar 

  10. Selmer C, Olesen JB, Hansen ML, Lindhardsen J, Olsen AM, Madsen JC, Faber J, Hansen PR, Pedersen OD, Torp-Pedersen C, et al. The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study. BMJ. 2012;345, e7895. Epub 2012 Nov 27.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Collet TH, Gussekloo J, Bauer DC, den Elzen WP, Cappola AR, Balmer P, Iervasi G, Asvold BO, Sgarbi JA, Völzke H, Gencer B, Maciel RM, Molinaro S, Bremner A, Luben RN, Maisonneuve P, Cornuz J, Newman AB, Khaw KT, Westendorp RG, Franklyn JA, Vittinghoff E, Walsh JP, Rodondi N. Thyroid Studies Collaboration. Subclinical hyperthyroidism and the risk of coronary heart disease and mortality. Arch Intern Med. 2012;172(10):799.

    Article  CAS  PubMed  Google Scholar 

  12. Heeringa J, Hoogendoorn EH, van der Deure WM, Hofman A, Peeters RP, Hop WC, den Heijer M, Visser TJ, Witteman JC. High-normal thyroid function and risk of atrial fibrillation: the Rotterdam study. Arch Intern Med. 2008;168(20):2219–24. doi:10.1001/archinte.168.20.2219.

    Article  PubMed  Google Scholar 

  13. Gammage MD, Parle JV, Holder RL, Roberts LM, Hobbs FD, Wilson S, Sheppard MC, Franklyn JA. Association between serum free thyroxine concentration and atrial fibrillation. Arch Intern Med. 2007;167(9):928.

    Article  CAS  PubMed  Google Scholar 

  14. Xu D, Murakoshi N, Sairenchi T, Irie F, Igarashi M, Nogami A, Tomizawa T, Yamaguchi I, Yamagishi K, Iso H, Ota H, Aonuma K. Anemia and reduced kidney function as risk factors for new onset of atrial fibrillation (from the Ibaraki prefectural health study). Am J Cardiol. 2015;115(3):328–33. doi:10.1016/j.amjcard.2014.10.041. Epub 2014 Nov 12.

    Article  PubMed  Google Scholar 

  15. Alonso A, Lopez FL, Matsushita K, Loehr LR, Agarwal SK, Chen LY, Soliman EZ, Astor BC, Coresh J. Chronic kidney disease is associated with the incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study. Circulation. 2011;123(25):2946.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Watanabe H, Watanabe T, Sasaki S, Nagai K, Roden DM, Aizawa Y. Close bidirectional relationship between chronic kidney disease and atrial fibrillation: the Niigata preventive medicine study. Am Heart J. 2009;158(4):629.

    Article  PubMed  Google Scholar 

  17. Fatemi O, Yuriditsky E, Tsioufis C, Tsachris D, Morgan T, Basile J, Bigger T, Cushman W, Goff D, Soliman EZ, et al. Impact of intensive glycemic control on the incidence of atrial fibrillation and associated cardiovascular outcomes in patients with type 2 diabetes mellitus (from the Action to Control Cardiovascular Risk in Diabetes Study). Am J Cardiol. 2014;114(8):1217–22. Epub 2014 Jul 30.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Dublin S, Glazer NL, Smith NL, Psaty BM, Lumley T, Wiggins KL, Page RL, Heckbert SR. Diabetes mellitus, glycemic control, and risk of atrial fibrillation. J Gen Intern Med. 2010;25(8):853–8. doi:10.1007/s11606-010-1340-y. Epub 2010 Apr 20.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Devereux RB, Roman MJ, Paranicas M, O'Grady MJ, Lee ET, Welty TK, Fabsitz RR, Robbins D, Rhoades ER, Howard BV. Impact of diabetes on cardiac structure and function: the strong heart study. Circulation. 2000;101(19):2271.

    Article  CAS  PubMed  Google Scholar 

  20. Tonje Amb Aksnes, Roland E. Schmieder, Sverre Erik Kjeldsen, Sajda Ghani, Tsushung Augie Hua, Stevo Julius. Impact of New-Onset Diabetes Mellitus on Development of Atrial Fibrillation and Heart Failure in High-Risk Hypertension (from the VALUE Trial. Received: September 7, 2007; Received in revised form: October 9, 2007; Accepted: October 9, 2007; Published Online: January 17, 2008

    Google Scholar 

  21. Cha YM, Redfield MM, Shen WK, Gersh B. Atrial fibrillation and ventricular dysfunction: a vicious electromechanical cycle. Circulation. 2004;109(23):2839.

    Article  PubMed  Google Scholar 

  22. Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, D'Agostino RB, Murabito JM, Kannel WB, Benjamin EJ. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107(23):2920.

    Article  PubMed  Google Scholar 

  23. Hsieh MH, Tai CT, Tsai CF, et al. Mechanism of spontaneous transition from typical atrial flutter to atrial fibrillation: role of ectopic atrial fibrillation foci. Pacing Clin Electrophysiol. 2001;24:46.

    Article  CAS  PubMed  Google Scholar 

  24. Archer SL, James KE, Kyernen LR, et al. Role of transesophageal echocardiography in the detection of left atrial thrombus in patients with chronic non-rheumatic atrial fibrillation. Am Heart J. 1995;130:287–95.

    Article  CAS  PubMed  Google Scholar 

  25. Douen AG, Sabih M, Pageau N. Thrombus detection by echocardiography in patients with acute ischemic stroke and chronic or new-onset atrial fibrillation. J Stroke Cerebrovasc Dis. 2008;17(4):208–11.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Baylor College of Medicine, Houston, TX, USA

    Adriana Thomas MD

  2. Emergency Department, Ben Taub General Hospital, Houston, TX, USA

    Adriana Thomas MD

  3. Department of Emergency Medicine, Emergency Center, Ben Taub General Hospital, Baylor College of Medicine, 1504 Taub Loop, Houston, TX, 77030, USA

    Zubaid Rafique MD, FACEP

Authors
  1. Adriana Thomas MD
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Corresponding author

Correspondence to Zubaid Rafique MD, FACEP .

Editor information

Editors and Affiliations

  1. Baylor College of Medicine, Department of Emergency Medicine Baylor College of Medicine, HOUSTON, Texas, USA

    W. Frank Peacock

  2. Department of Emergency Medicine, Beaumont Health System, William Beaumont Hospital, William Beaumont School of Medicine, Oakland University, Royal Oak, Michigan, USA

    Carol L. Clark

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© 2016 Springer International Publishing Switzerland

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Thomas, A., Rafique, Z. (2016). Diagnostic Testing in the Emergency Department of Atrial Fibrillation. In: Peacock, W., Clark, C. (eds) Short Stay Management of Atrial Fibrillation. Contemporary Cardiology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-31386-3_8

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  • DOI: https://doi.org/10.1007/978-3-319-31386-3_8

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  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-31384-9

  • Online ISBN: 978-3-319-31386-3

  • eBook Packages: MedicineMedicine (R0)

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