Atrial fibrillation: symptoms, assessment and care

Atrial fibrillation is an irregular heart rhythm that starts in the heart's upper chambers.

The upper chambers can beat in an uncoordinated way, so the pulse may feel fast, uneven or both. The condition is often called AF. Some people notice clear symptoms, while others learn about it during an examination for another reason.

Atrial fibrillation often presents with palpitations, a sensation of fluttering or pounding in the chest. Dizziness, shortness of breath, tiredness, chest discomfort and fainting can also occur. The symptom pattern may be intermittent or persistent.

Call emergency services for sudden weakness or numbness on one side, facial drooping, difficulty speaking, sudden loss of vision, severe chest pain, collapse, or sudden severe breathlessness. These signs need urgent assessment whether or not AF has already been diagnosed.

AF can be associated with changes in the heart’s structure or electrical signalling. High blood pressure, heart valve problems, coronary artery disease, heart failure and an overactive thyroid can contribute. It can also appear without a single clear cause.

Alcohol, stimulant medicines, dehydration, acute illness and poor sleep may make an episode more likely in some people. A clinician will consider medicines, medical history and current health rather than assuming one trigger explains every episode.

AF may occur in episodes that stop on their own, last longer, or become an ongoing rhythm pattern. Its course differs between people. Tracking symptoms and pulse changes can support decisions about treatment and follow-up.

An irregular rhythm can reduce how effectively the heart fills and pumps. It can also allow blood to pool in part of the upper chambers, which is why clinicians assess clot-related risk carefully.

Increasing age, high blood pressure, diabetes, obesity, sleep apnoea, thyroid disease and other heart conditions are among factors a clinician may review. Family history and lifestyle can also be relevant. Having a factor does not confirm that a person has AF.

Regular health reviews can identify blood pressure, thyroid or heart issues that may need attention. Tell a clinician about snoring, daytime sleepiness, alcohol intake and any over-the-counter products or supplements.

An electrocardiogram records the heart’s electrical activity and can confirm AF when the rhythm is present. If symptoms come and go, a clinician may arrange longer rhythm monitoring. Blood tests and heart imaging may be considered to look for contributing conditions.

A pulse check alone can suggest an irregular rhythm but cannot establish the cause. Bring a list of symptoms, medicines and previous heart results if you have them.

Care aims to relieve symptoms, manage heart rate or rhythm, and reduce the chance of harmful blood clots when appropriate. The plan depends on symptoms, other conditions and the particular risks identified during assessment.

Medicines may slow the heart rate, help maintain a regular rhythm or reduce clot formation. Some people are referred for a procedure that restores rhythm or treats the abnormal electrical pathway. Anticoagulation management involves balancing clot prevention with bleeding risk and reviewing medicines safely.

Take medicines exactly as directed and do not stop an anticoagulant without clinical advice. Report unusual bleeding, black stools, vomiting blood, a significant head injury or a fall promptly, especially when taking medicine that affects clotting.

Keep appointments for rhythm, blood pressure and medicine reviews. Gentle, regular activity, sleep, hydration and moderation with alcohol can be discussed as part of a personal plan. Seek advice before starting supplements or new over-the-counter medicines.

Blood clots formed during AF can travel to the brain and cause a stroke or a transient ischaemic attack. Ongoing rapid heart rate can also strain the heart and may contribute to heart failure. These are risks clinicians work to reduce through assessment and treatment.

Not every case can be prevented, but managing blood pressure, diabetes, thyroid disease and sleep apnoea can support heart health. Avoid tobacco, discuss alcohol use honestly and seek review for new palpitations or a changed exercise tolerance.

Start with a GP or urgent-care clinician for new symptoms. Cardiology input may be needed when AF is confirmed, symptoms remain troublesome, rhythm-control procedures are considered or decisions about clot prevention are complex. Bring your medicine list and any home pulse records.