Signs & Symptoms

i've taken these stuff from emedicine.medscape.com =)

Initial history

• Clinical type of atrial fibrillation should be documented (paroxysmal, persistent, or permanent)
• Type, duration, and frequency of symptoms should be assessed
• Precipitating factors should be assessed (ie, exertion, sleep, caffeine, alcohol use)
• Modes of termination should be assessed (ie, vagal maneuvers)
• Prior antiarrhythmics and rate-controlling agents used should be documented
• Presence of underlying heart disease should be assessed
• Any previous surgical or percutaneous atrial fibrillation ablation procedures should be documented
  

Common symptoms

Those needing immediate attention include the following:

• Decompensated CHF
• Hypotension
• Uncontrolled angina/ischemia
  

Less severe symptoms and patient complaints may include the following:

• Palpitations
• Fatigue or poor exercise tolerance
• Presyncope, or syncope
• Generalized weakness, dizziness, fatigue

Signs

• irregularly irregular pulse, tachycardic, with heart rates typically in the 110-140 range, but rarely over 160-170 range.
• cardiac murmurs for patients with valvular heart disease with coexisting atrial fibrillation
• rales (small clicking, bubbling, or rattling sounds in the lung) consistent with congestive heart failure (CHF).
  - Crackles are often associated with inflammation or infection of the small bronchi, bronchioles, and alveoli.
  - Crackles that don't clear after a cough may indicate pulmonary edema or fluid in the alveoli due to heart failure.
• deep venous thrombosis (DVT) or hyperthyroidism. (Thyroid hormone contributes to arrythmogenic activity by altering the electrophysiological characteristics of atrial myocytes by shortening the action potential duration, enhancing automaticity and triggered activity in the pulmonary vein cardio myocytes)
• Because thromboembolic phenomenon is common in atrial fibrillation, signs of transient ischemic attack (TIA)/cerebrovascular accident (CVA) or peripheral embolization (cool/cold pulseless extremity or left upper quadrant pain of splenic infarct) may be discovered.

Physical examination (extra signs)

• Vital signs: Heart rate, blood pressure, respiratory rate, and oxygen saturation are particularly important in evaluating hemodynamic stability and adequacy of rate control in atrial fibrillation.
• Head and neck: May reveal exophthalmos (an abnormal protrusion of the eyeball; also labeled as proptosis), thyromegaly, elevated jugular venous pressures, or cyanosis. Carotid artery bruits (vascular murmur, reflecting turbulence of flow) suggest peripheral arterial disease and increase the likelihood of comorbid CAD.
• Pulmonary: May reveal evidence of heart failure (ie, rales or pleural effusion).
• Cardiac: A displaced point of maximal impulse or S3 (extra heart sound after S1 & S2) suggest ventricular enlargement and elevated left ventricular pressure. A prominent P2 points (pulmonic component of the 2nd heart sound) to the presence of pulmonary hypertension. Thorough palpation and auscultation are necessary to evaluate for valvular heart disease or cardiomyopathy.
• Abdomen: Ascites (excess fluid in the peritoneal cavity), hepatomegaly or hepatic capsular tenderness suggest right ventricular failure or intrinsic liver disease.
• Lower extremities: Examination of the lower extremities may reveal cyanosis, clubbing or edema. Assessment of peripheral pulses may lead to the diagnosis of peripheral arterial disease or diminished cardiac output.
• Neurologic: Evidence of prior stroke and increased reflexes is suggestive of hyperthyroidism.