Two clinical manifestations of persistent atrial fibrillation

Persistent atrial fibrillation occurs in many middle-aged and elderly people. Persistent atrial fibrillation is not as simple as the number of heart beats being higher than that of normal people. Its frequency is also different from that of normal people, and the number of heart beats is irregular. Therefore, patients with persistent atrial fibrillation must understand their bodies well and not delay treatment. Today I will share with you the characteristics of persistent atrial fibrillation.

1. Clinical manifestations of patients with paroxysmal atrial fibrillation

(1) More common in male patients: often without organic heart disease.

(2) Paroxysmal atrial fibrillation may occur frequently, and dynamic electrocardiogram may show that the attacks may last from a few seconds to several hours.

(3) It is often accompanied by frequent premature atrial contractions, which can induce atrial fibrillation.

(4) The coupling interval of atrial premature contractions is mostly <500ms, often with P-on-T phenomenon, which can induce short-term atrial fibrillation.

(5) Sympathetic nerve excitement, such as excitement and exercise, can induce atrial fibrillation.

(6) Younger patients with focal atrial fibrillation have relatively fewer atrial fibrillation episodes. The atria are often small, and in most cases only one pulmonary vein is affected.

(7) When paroxysmal atrial fibrillation occurs, if the frequency is not fast, there may be no obvious symptoms. If the heart rate is fast, the patient may complain of palpitations, trepidation, chest tightness, shortness of breath, pounding heart, irritability, fatigue, etc. Auscultation reveals irregular heartbeat, unequal strength and speed of heart sounds, short and slow pulse, polyuria, etc. If the ventricular rate is too fast, it can also cause low blood pressure or even fainting.

2. Clinical manifestations of patients with persistent and chronic atrial fibrillation

(1) The symptoms of persistent (or chronic) atrial fibrillation are related to the underlying heart disease and also to the speed of the ventricular rate. There may be palpitations, shortness of breath, chest tightness, and fatigue, especially after physical activity, when the ventricular rate increases significantly. Syncope may also occur, especially in elderly patients, due to cerebral hypoxia and vagal hyperactivity.

(2) Irregular heart rhythm: The first heart sound is uneven in strength and intervals. The ventricular rate of untreated atrial fibrillation is generally between 80 and 150 beats/min, rarely exceeding 170 beats/min. A heart rate of >100 beats/min is called rapid atrial fibrillation; a heart rate of >180 beats/min is called extreme atrial fibrillation. The pulse is short and clumsy.

(3) It can induce heart failure or aggravate existing heart failure or underlying heart disease, especially when the ventricular rate exceeds 150 beats/min, which can aggravate myocardial ischemia symptoms or induce angina pectoris.

(4) The susceptibility to thrombosis is increased, making embolic complications more likely to occur. If atrial fibrillation persists for more than three days, blood clots may form in the atria. Older age, organic heart disease, enlarged left atrial diameter, and increased plasma fibrinogen are all risk factors for thromboembolic complications.