The following symptoms and complaints may indicate atrial fibrillation (VHF):
Leading symptoms
- Irregular (arrhythmia absoluta) and also usually too fast pulse (tachyarrhythmia absoluta (TAA) – pulse: > 100 beats per minute).
- Palpitations (feeling the heartbeat) (43%).
- Vertigo (dizziness) (37%), syncope (momentary loss of consciousness).
Other possible symptoms:
- Signs of heart failure (cardiac insufficiency).
- Dyspnea (shortness of breath) (49%)
- Angina pectoris symptoms (20%)
- Hypotension (low blood pressure)
- Peripheral embolism (especially ischemic cerebral infarction).
- Reduced exercise tolerance, fatigue (49%).
Notice: When AF is associated with hemodynamic instability (condition in which the circulation is impaired to a clinically relevant degree), additional underlying disease must be ruled out, such as hyperthyroidism (hyperthyroidism), pulmonary embolism, hypertensive emergency with (pre)pulmonary edema, exacerbated chronic obstructive pulmonary disease (COPD), decompensated heart failure (heart failure).
Atrial fibrillation is often asymptomatic! (about a quarter of patients are subjectively symptom-free, i.e. these patients do not even feel the arrhythmia)
In Germany, almost two thirds of all patients with newly diagnosed non-valvular atrial fibrillation are asymptomatic or oligosymptomatic. This group differs from the “symptomatic AF” subgroup in the following characteristics:
- Patients were older than symptomatic patients (42.8 vs. 38.8% older than 75 years)
- More often male than symptomatic patients (59.4 vs. 51.2%)
- More often permanent atrial fibrillation than symptomatic patients (10.2 vs. 4.5%)
- As expected, the proportion of patients with heart failure (18.1 vs. 36.2%) or decreased left ventricular ejection fraction of <40% (28.9 vs. 37.1%) was lower in the group with asymptomatic/oligosymptomatic AF.
- 17.8% had suffered an apoplexy before inclusion in the study (vs. 6% in the subgroup with symptomatic AF)
Additional notes
- VCF patients with positive family history had more severe symptoms:
- Asymptomatic: 31.6% (vs. 39.1% in patients with blank history).
- Moderate symptoms: 48.2% (vs. 44.9%) (vs. 1.7%) were physically disabled by AF
- Severe symptoms: 17.5% (vs. 14.2%).
- Physically disabled: 2.6% (vs. 1.7%).
- Familial VHF patients had a mean of five years earlier disease; concomitant diseases such as coronary artery disease (CAD) or chronic obstructive pulmonary disease were less common.
- Palpitations appear to have the greatest relevance to treatment decisions in VHF patients. In a European atrial fibrillation registry, these complaints were associated with the greatest likelihood of cardioversion (odds ratio, OR: 1.32) or catheter ablation (OR: 2.02) in the following year.
Gender differences (gender medicine)
- Women (as distinct from men):
- More often symptomatic and impaired in their daily activities/worse quality of life than male participants
- Higher risk of apoplexy or embolism outside the CNS.
- Higher overall survival rate and lower risk of cardiovascular death
