Differential Diagnosis by Shakir and JB

Atrial Fibrillation

- Occuring in 5-10% of patients over 65 years

- Deterioration of exercise capacity

- Irregular pulse

- ECG shows fine oscillations of the baseline

- No clear P waves

- QRS rhythm is rapid and irregular

- Ventricular rate around 120-180 per minute

- Palpitations

- Decreased blood pressure

- Weakness

- Dizziness

- Confusion

- Shortness of breath

- Chest pain

Sick Sinus Syndrome

-Fatigue

-Dizziness

-Syncope

-Chest pains

-Insomnia

-Confusion

-Palpitations

Endocarditis

- Fever

- Chills

- Heart murmurs

- Fatigue

- Aching joints and muscles

- Night sweats

- Shortness of breath

- Paleness

- Persistent cough

- Swelling in lower limbs or abdomens

- Weight loss

- Haematuria

- Spleen tenderness

- Osler's nodes (red tender spots under skin of finger)

- Petechiae (tiny purple red spots on skin, sclera, or inside mouth)

Holiday Heart Syndrome

- Acute cardiac rhythm and/or conduction disturbance

- Supraventricular tachyarrythmia

- Associated with heavy ethanol consumption with no other clinical evidence of heart disease

- Resolve rapidly during subsequent abstinence from alcohol use

- ECG shows prolongation of the PR, QRS, and QT intervals compared with patient's who experienced arrhythmias in the abscence of alcohol consumption

- Palpitations

- Chest discomfort

- Shortness of breath

- Feeling of faintness

Wolff-Parkinson-White Syndrome

- Electrical Syndrome arrive at the ventrical too soon

- A category of electrical abnormality known as "pre-excitation syndromes"

- ECG will show that an extra pathway or shortcut exists from the atria to the ventricles

- May have dizziness, chest palpitations, fainting or rarely, cardiac arrest

Supraventricular Tachycardias (SVTs)

-Unlike atrial fibrillation, SVTs arise from atrium or atrioventricular joint

- Has P wave as SA node will be working

Paroxysmal Atrial Fibrillation

- Irregular in rhythm

- Start abruptly

- Terminate as suddenly

- Lead to symptoms such as syncope, presyncope, dyspnoea or chest pain

- May have episodes only a few times a year or every day

Atrial Flutter

- Shares clinical presentation with atrial fibrillation

- Organized atrial rhythm with an atrial rate between 250 & 350 beats per minute

- ECG shows regular sawtooth- like atrial flutter waves (F waves) between QRS complexes

- Ventricular rate of 150 b.p.m.

- Occasionally heart rate of 300 b.pm.

Reference : Clinical Medicine by Kumar & Clark, http://heart.emedtv.com, www.emedicine.medscape.com, www.mayoclinic.com