Atrial Fibrillation (AF)

🔍 When to Suspect

An irregularly irregular pulse, with or without symptoms like palpitations, dizziness, shortness of breath, or fatigue

From the full topic in The Ocean Library: Atrial Fibrillation (AF)

🧭 When to suspect

Atrial fibrillation (AF) is the commonest sustained arrhythmia. Suspect it whenever you find an irregularly irregular pulse, or in anyone with palpitations, breathlessness, dizziness, chest discomfort or fatigue. Many people are asymptomatic: AF is often found incidentally – for example when checking the pulse before a blood pressure reading – or only after a complication such as stroke/TIA or heart failure.

Diagnosis is electrical, not clinical. An irregular pulse is the trigger to record a 12-lead ECG, which shows absent P waves and an irregularly irregular QRS. A single normal ECG does not exclude paroxysmal AF – if symptoms are intermittent, arrange ambulatory monitoring. Atrial flutter is assessed and anticoagulated along the same lines as AF.

The three primary-care tasks are best remembered as the ABC pathway: Anticoagulation to avoid stroke (the priority), Better symptom control (usually rate control), and Comorbidity and cardiovascular-risk management.

Pattern	Definition
Paroxysmal	Self-terminating, usually within 48 hours and by definition within 7 days
Persistent	Continuous for > 7 days, or requires cardioversion to terminate
Long-standing persistent	Continuous for > 12 months when a rhythm-control strategy is still being pursued
Permanent	AF accepted; no further attempts to restore sinus rhythm

Stroke risk is the same whatever the pattern – asymptomatic and paroxysmal AF are not low-risk AF, and the anticoagulation rules apply equally.

Source: NICE NG196

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