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On a walk, you notice a strange sensation in the middle of your chest. This irregularity may last only a few seconds but leaves you nervous for the rest of the week thinking about what could it be. Is it atrial fibrillation or is it just arrhythmia?

Atrial fibrillation is common disease worldwide and can be seen in up to 17 percent of patients over the age of 80 [1]. It is a dangerous disease and the quicker you recognize the signs and symptoms to start your management, the more effective your treatment for atrial fibrillation will be. Many risk factors can lead to your atrial fibrillation such as: 

  • hypertension,
  • diabetes and
  • heart disease [2].

As patient ages, there is a greater chance where they may start to experience some alarming symptoms. Unfortunately, atrial fibrillation can manifest in a number of different ways like a constant, paroxysmal or even asymptomatic [2]. It is important to be aware of these alarm symptoms in order to get to your cardiologist or cardiac surgeon as soon as possible. 

Symptoms of atrial fibrillation and other common arrhythmias

Atrial fibrillation will most generally present with non-specific findings such as: 

  • breathlessness,
  • heart palpitations,
  • dizziness and
  • chest discomfort [3].

In the Euro Heart Survey of Atrial Fibrillation, as many as 69% of patients were symptomatic at the time of the survey; among asymptomatic patients (not showing symptoms), 54% of the symptoms were previously experienced [4]. Nevertheless, there are far too many patients that remain asymptomatic to describe physical findings to watch out for.

One test does stand above the rest in terms of sensitivity. Patients that present with an irregular pulse that lasted for over 20 seconds were subsequently diagnosed with atrial fibrillation in 98 percent of cases [5]. 

It is paramount to be able to identify the difference between atrial fibrillation and other arrhythmias because 

  • supraventricular tachycardia,
  • atrial flutters and
  • other conduction defects 

are possible road blocks to make your diagnoses of atrial fibrillation nearly impossible based on clinical presentation alone [6]. All these arrhythmias can present with breathlessness, heart palpitations and chest discomfort [7]. As you may remember from the trilogy of symptoms most likely for atrial fibrillation, these symptoms mirror those of other less severe arrhythmias almost perfectly so it is impossible to accurately diagnose your atrial fibrillation from how you feel on the surface. This is when you will need to go to your local cardiologist to get a better idea of what is going on inside of you. 

How to diagnose your atrial fibrillation and how to tell the difference between atrial fibrillation and arrhythmia

When you first visit your cardiologist, you have started the first important step in your atrial fibrillation treatment. He will perform a number of different tests to help classify the arrhythmia you are experiencing in order to begin the appropriate therapy. The cardiologist is an essential component of this algorithm because he will be able to pinpoint where the problem is in the heart that is causing your heart palpitation.

Chances are, the cardiologist may not have had enough time to fully explain what an arrhythmia is so here is a crash-course in cardiac conduction. The heart uses an electrical signal from the top of your heart to the middle and bottom parts in order to coordinate one beat. The top of the heart is made up of two atria and the bottom of the heart is made up of two ventricles. An electric pulse is generated in the atria and travels to the middle part of the heart in an area called the Sinoatrial Node (SA node). This regulates how many times a minute your heart will beat. It also allows the heart signal to build up enough to be strong enough to cause the much bigger muscles that make up your ventricles to contract. Any problem along with pathway will cause an irregular heartbeat and it is up to the medical team to determine where and what that problem is. [8]

12-lead electrocardiogram (EKG) 

The first way to do that and one of the key factors for atrial fibrillation treatment success is attaching a 12-lead electrocardiogram (EKG) to the patient in order to check the heart rhythm. 12-lead electrocardiogram (EKG) is very sensitive and is able to detect even the slightest irregular heartbeat by analyzing the conduction pathway of the heart and doctors have enough skill to be able to read this and determine what it is. EKG will be able to instantaneously tell if the problem lies within the atria or the ventricle to focus only a specific area.

Advanced software can be used to quickly analyze what the pattern of the heart is depicting and studies find that this procedure alone will be able to diagnose 93 percent of cases. You will also be able to rule out atrial fibrillation in 90 percent of cases [9].

This simple slip of paper will also show distinctive patterns that help doctors target what is causing the problem. Arrhythmias like atrial flutter look very different than atrial fibrillation and will have a large number of small p-waves compared to what is likely with atrial fibrillation. You will also be able to notice other likely heart conduction defects like Wolff-Parkinson-White Syndrome by specific markings called delta waves that are very clear on EKG readings [10]. 

Holter monitor

In the event that you present to the doctor with a "shy" atrial fibrillation, you will be given a device called a Holter monitor that you take home with you and record your heart rate for the next 24 to 48 hours.

Holter monitor is entirely portable and easily attaches to your belt to give a doctor a better understanding of how your heart performs during your routine activities, during exercising, and even while you are sleeping.

Essentially, you are taking a digit EKG for a longer period of time to get more data in the event your first EKG test is not conclusive. This will further help tell the difference between atrial fibrillation and other arrhythmias. [11]

Transesophageal echocardiogram (TEE)

Once it has been established that you are suffering from atrial fibrillation and not any other irregular heartbeat that it may be confused with, the last step is the most unpleasant for patients. This is called a trans-esophageal echocardiogram (TEE). A tube is inserted in a patient's throat (don't worry, we give anesthesia) and then a device similar to a standard ultrasound machine sends radio waves to make a 3-D picture of what is going on with your heart valves. This machine will be able to see if there are any irregularities like your heart valves moving improperly or if there are clots already forming on the valve's surface. Cardiologists use this information to determine what type of anti-coagulant a patient will need to be on to make sure they avoid some of the more dangerous complications of atrial fibrillation like strokes, pulmonary emboli, and heart attacks. [12]

All three tests are absolutely essential, along with a patient's past medical history, to determine what type of arrhythmia a patient is suffering from and what needs to be done. 

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