Atrial Fibrillation (cont.)
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Atrial Fibrillation (A Fib) Diagnosis
The doctor will often begin by asking the patient about their medical history to help determine the severity of symptoms. The doctor will assess if any associated factors (for example, alcohol or caffeine intake) may be contributing to the patient's symptoms. The doctor will also listen to the patient's heartbeat and lungs. The evaluation may include the following tests:
Electrocardiogram (ECG or EKG): This is the primary test to determine when an arrhythmia is atrial fibrillation. The ECG can help the doctor distinguish A fib from other arrhythmias that may have similar symptoms (atrial flutter, supraventricular tachycardia, or runs of ventricular tachycardia). The test can also sometimes reveal damage (ischemia) to the heart, if there is any.
The following illustrations show the usual ECG tracing from a patient with A fib; the second figure shows the different appearance between a normal (single lead) ECG tracing and the irregular appearance of an atrial fibrillation (single lead) ECG tracing. The atrial tracing for the A fib tracing shows a slowed irregular heartbeat of A fib, where the irregular waves are easily seen before the heartbeat (Figure 2). These waves can be seen if the heartbeat is slowed; they are difficult to see in patients with a rapid heartbeat shown in Figure 3.
Lab tests: There is no blood test that can confirm that a person has atrial fibrillation. However, blood tests may be done to check for certain underlying causes of atrial fibrillation and to rule out heart damage, as from a heart attack. People already taking medication for atrial fibrillation may need blood tests to make sure there is enough of the drug (usually digoxin) in their system to work effectively. Blood tests that may be done to rule out other conditions include:
Chest x-ray: This imaging test is used to evaluate for complications such as fluid in the lungs or to estimate heart size.
Echocardiogram or transesophageal echocardiogram: This is an ultrasound test that uses sound waves to make a picture of the heart while it is beating.
Ambulatory electrocardiogram (Holter monitor): This test involves wearing a monitor similar to that used for an ECG for a period of time (usually 24-48 hours) to try to document the arrhythmia while people go about their everyday activities.
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