Clinical evaluation

A. Atrial fibrillation (AF) may manifest only as fatigue caused by impaired cardiac output or the patient may have no symptoms. Palpitations, shortness of breath or chest pain may occur, and syncope may infrequently accompany AF. Symptoms of myocardial ischemia and angina may be caused by the rapid ventricular rate. Paroxysmal AF may cause symptoms that abate and recur.

B. The cause of the atrial fibrillation should be identified. Precipitating causes, such as hyperthyroidism, electrolyte abnormalities, and drug toxicity, should be excluded. Stimulant abuse, excess tobacco, alcohol, caffeine, chocolate, over-the-counter cold remedies, and street drugs should be sought. AF may be associated with a recent acute illness, such as pneumonia.

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