Diagnosis of AF? Is there more than one way?

[Dustymiller]

I visited A & E last evening after what doctor feels to have been an episode of AF. However, once there, everything settled down and although pulse rate was still high nothing showed up on ECG. I have had minor episodes of symptoms before (not realising what they were) but this one was really scary and I thought I was dying!! I felt my heart stop and it seemed to do a somersault!! I have now been advised to go to GP and then on for referral to Cardio. Will a 24 hour ECG diagnose AF? Is there any other way of diagnosing it? I am concerned that if I don't have an episode in the 24 hour period I have the machine, no treatment will be given.

[SRMGrandma Volunteer]

Hi Dustymiller,

Many of us have been through that scary time when we thought we were dying when we first experienced AF. To feel like your heart is going wild in your chest is NOT a good feeling at all. To thoroughly diagnose AF a variety of tests should be done. Among them are: An EKG or regular cardiogram, which you've had before; a Holter monitor for 24-48 hours to record your heart activity; an event monitor for 1 month or longer where you are told to push a button when you feel anything unusual and speak into it to tell if you were short of breath or felt a palpitation, at a particular time and they can correlate that with what is happening on your rhythm strip at that moment; a cardiac stress test to evaluate your heart with activity; and an echocardiogram to see if the heart is the right size and to see if all the valves are working properly, or if there are areas of poor blood, and to watch the heart contracting. Blood work should be done including a thyroid panel to rule out thyroid as a cause of irregular or rapid heart beat. Once you health care provider has all that information, then a diagnosis of AF can be made. Hope you are feeling better and get the care that you need.

[Dustymiller in reply to SRMGrandma]

Thank you so much this is really helpful.. In fact, reading other comments to questions on this site have really helped me to understand I am not alone.

[BobD Volunteer]

That just about covers it ! I had loads of events , all missed by doctors and hospitals over time before I was seen by my GP whilst actually in AF.. I then had a 14 day event monitor where I had to press buttons when things felt odd and each night I downloaded over the telephone to the computer at the hospital. When I took the machine back they already knew that I had paroxysmal AF (it comes and goes) and prepared a treatment plan but that was in 2004.

Be assured that AF wont kill you but there are risks including increased stroke risk so it is important to get properly diagnosed and under treatment. I guess the secret of you last sentence is not to let that happen. My advice would be to read all the fact sheets available from AFA main website and arm yourself with as much knowledge as you can so that you can have an informed discussion with your cardiologist. That way you will be a partner in your own treatment rather than just a customer.

BobD

[Langara]

Hi SRMGrandma - I was interested to read above when you wrote that to thoroughly diagnose AF a variety of tests should be done including "a Holter monitor for 24-48 hours to record your heart activity; an event monitor for 1 month or longer where you are told to push a button when you feel anything unusual and speak into it to tell if you were short of breath or felt a palpitation, at a particular time and they can correlate that with what is happening on your rhythm strip at that moment; a cardiac stress test to evaluate your heart with activity; and an echocardiogram to see if the heart is the right size and to see if all the valves are working properly"

All I had was an ECG, a blood test and a chest Xray, and from that it was determined I am an AF sufferer. Do you think that was sufficient or that perhaps I should ask for further tests?

[SRMGrandma Volunteer in reply to Langara]

It is quite possible that you were easy to diagnose by your ECG by virtue of the fact you were experiencing AF while you had that test. But to thoroughly investigate the condition of your heart, an echocardiogram and a cardiac stress test should be part of the work up. AF is a problem with the heart's electrical conduction system. To be sure your heart is structurally and functionally sound, I would indeed want those other tests.

[mumknowsbest Volunteer]

Hi

I think SRM Grandma is from America and maybe all these tests are done as routine?

I was diagnosed because I was in Af when I had the ECG, During the last 10 years or so I have indeed had echo's and a stress test, the stress test was because I was admitted with chest pain, The other test as you say check your heart is sound but all you need to confirm AF is an ecg showing you are in it.

[SRMGrandma Volunteer in reply to mumknowsbest]

Yes, I do live in the U.S. and I wouldn't call the tests routine, but the guidelines for diagnosis seem to be the same in the US and in Europe from what I've read. When I was first diagnosed the cardiologist simply suggested a stress test, but once I went to an EP, he felt it important to know whether or not the heart had other structure or function issues. AF is frequently caused by heart valve problems and an echo is needed to tell if that is the cause.