How Is Atrial Fibrillation Diagnosed?
Sometimes people have atrial fibrillation (AF), but
don't have symptoms. For these people, AF is often found during a physical exam
or EKG
(electrocardiogram) test done for another purpose. Other times, AF is diagnosed
after a person goes to the doctor because of symptoms.
To understand why a person has AF and the best way
to treat it, the doctor will want to discover any immediate or underlying
causes. Doctors use several methods to diagnose AF, including family and
medical history, a physical exam, and several diagnostic tests and
procedures.
Specialists Involved
A primary care doctor often is involved in the
initial diagnosis and treatment of AF. These doctors can include:
- Family practitioners
- Internists
Doctors who specialize in the diagnosis and
treatment of heart disease also may be involved, such as:
- Cardiologists (doctors who take care of adults
with heart problems)
- Electrophysiologists (e-LEK-tro-fiz-e-OL-o-jists;
cardiologists who specialize in
arrhythmias)
Family and Medical History
The doctor will ask questions about:
- Symptoms. What symptoms are you having? Have you
had palpitations (a feeling of a strong or fast heartbeat)? Are you dizzy or
short of breath? Are your feet or ankles swollen (a possible sign of
heart
failure)? Do you have any chest pain?
- Medical history. This includes other health
problems, such as a history of
heart
disease,
high
blood pressure,
lung
disease, diabetes, or thyroid problems.
- Family medical history. Does anyone in your
family have a history of AF? Has anyone in your family ever had heart disease
or high blood pressure? Has anyone had thyroid problems? Are there other
illnesses or health problems in your family?
- Health habits. These include smoking and alcohol
or caffeine use.
Physical Exam
The doctor will do a complete cardiac exam,
listening to the rate and rhythm of your heartbeat and taking your pulse and
blood pressure reading. The doctor will likely check to see whether you have
any sign of problems with your heart muscle or valves. He or she will listen to
your lungs to check for signs of heart failure.
The doctor also will check for swelling in the legs
or feet and look for an enlarged thyroid gland or other signs of
hyperthyroidism.
Diagnostic Tests and Procedures
EKG
An EKG is a simple test that detects and records the
electrical activity of your heart. It is the most useful test for diagnosing
AF. It shows how fast the heart is beating and its rhythm (steady or
irregular). It also records the timing of the electrical signals as they pass
through each part of the heart.
A standard EKG test only records the heartbeat for a
few seconds. It wont detect an AF episode that doesnt happen during
the test. To diagnose paroxysmal AF, the doctor may ask you to wear a portable
EKG monitor that can record your heartbeat for longer periods. The two most
common types of portable EKGs are Holter and event monitors.
Holter Monitor
Also called an ambulatory EKG, this device records
the electrical signals of the heart for a full 24- or 48-hour period. You wear
small patches called electrodes on your chest that are connected by wires to a
small, portable recorder. The recorder can be clipped to a belt, kept in a
pocket, or hung around your neck.
During the time youre wearing a Holter
monitor, you do your usual daily activities and keep a notebook, noting any
symptoms you have and the time they occurred. You then return both the recorder
and the notebook to the doctor to read the results. The doctor can see how your
heart was beating at the time you had symptoms.
Event Monitor
Event monitors are useful to diagnose AF that occurs
only once in a while. The device is worn continuously, but only records the
hearts electrical activity when you push a button. You push the button on
the device when you feel symptoms. Event monitors can be worn for 1 to 2
months, or as long as it takes to get a recording of the heart when symptoms
are occurring.
Other Tests Used to Diagnose Atrial Fibrillation
Echocardiogram
This test uses sound waves to create a moving
picture of your heart. An
echocardiogram
provides information about the size and shape of your heart and how well your
heart chambers and valves are functioning. The test also can identify areas of
poor blood flow to the heart, areas of heart muscle that arent
contracting normally, and previous injury to the heart muscle caused by poor
blood flow.
This test is sometimes called a transthoracic
echocardiogram. Its noninvasive and is done by placing an echo
probe on your chest wall. The procedure is the same technique used
for obtaining sonograms in pregnant women.
Transesophageal Echocardiogram
A transesophageal (trans-e-SOF-ah-ge-al)
echocardiogram, or TEE, takes pictures of the heart through your esophagus (the
tube leading from your mouth to your stomach). The atria are deep in the chest
and often cant be seen very well on a regular echocardiogram. A doctor
can see the atria much better with a TEE. In this test, the transducer is
attached to the end of a flexible tube thats guided down your throat and
into your esophagus. TEE is usually done while the patient under some sedation.
TEE is used to detect clots that may be developing in the atria because of
AF.
Blood Tests
These tests check the level of thyroid hormone and
the balance of your bodys electrolytes. Electrolytes are minerals in your
blood and body fluids that are essential for normal health and functioning of
your bodys cells and organs.
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