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Fibrilação Atrial

Sintomas

Pacientes com FA podem se queixar de palpitações no peito (sensação de batimento cardíaco acelerado, desconfortável, irregular), fraqueza, capacidade reduzida para atividades, fadiga, tontura, falta de ar ou dor no peito.17

Alguns pacientes são assintomáticos e não sabem da existência da arritmia até que seja descoberta durante um exame físico de rotina ou com quadro clínico de uma complicação associada com FA (por exemplo, AVC).

Identificação precoce

Não raramente, a FA se associa a comorbidades cardíacas e não cardíacas. Nesse sentido, a pesquisa e a exclusão de outros fatores relevantes, dependentes de história clínica e exame de doenças associadas, como doenças da tireoide, doença cardíaca estrutural e patologia intratorácica, são importantes.17 Portanto, na avaliação inicial, se fazem importantes a história clínica detalhada, o exame físico, incluindo tempo e, em caso de FA, duração, severidade, fatores precipitantes e doenças associadas, e os exames complementares, que incluem eletrocardiograma, ecocardiograma, para avaliar o tamanho do átrio esquerdo, a função ventricular e a presença de trombos, teste de esforço em pacientes com história de isquemia, função tireoidiana, exames bioquímicos, eletrólitos e enzimas cardíacas em pacientes com instalação aguda.

Referências

  1. Ball J, Carrington MJ, McMurray JJ, Stewart S. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int J Cardiol. 2013;167(5):1807-24.

  2. Zimerman LI, Fenelon G, Martinelli Filho M, Grupi C, Atié J, Lorga Filho A, et al.; Sociedade Brasileira de Cardiologia. Diretrizes brasileiras de fibrilação atrial. Arq Bras Cardiol. 2009;92(6 Supl 1):1-39.

  3. Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study. JAMA. 1994;271(11):840-4.

  4. Wang TJ, Larson MG, Levy D, Vasan RS, Leip EP, Wolf PA, et al. Temporal relations of atrial fibrillation and congestive heart failure and their joint influence on mortality: the Framingham Heart Study. Circulation. 2003;107(23):2920-5.

  5. Gami AS, Hodge DO, Herges RM, Olson EJ, Nykodym J, Kara T, et al. Obstructive sleep apnea, obesity, and the risk of incident atrial fibrillation. J Am Coll Cardiol. 2007;49(5):565-71.

  6. Frost L, Hune LJ, Vestergaard P. Overweight and obesity as risk factors for atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Am J Med. 2005;118(5):489-95.

  7. Conen D, Tedrow UB, Cook NR, Moorthy MV, Buring JE, Albert CM. Alcohol consumption and risk of incident atrial fibrillation in women. JAMA. 2008;300(21):2489-96.

  8. Chamberlain AM, Agarwal SK, Folsom AR, Duval S, Soliman EZ, Ambrose M, et al. Smoking and incidence of atrial fibrillation: results from the Atherosclerosis Risk in Communities (ARIC) study. Heart Rhythm. 2011;8(8):1160-6.

  9. Frost L, Frost P, Vestergaard P. Work related physical activity and risk of a hospital discharge diagnosis of atrial fibrillation or flutter: the Danish Diet, Cancer, and Health Study. Occup Environ Med. 2005;62(1):49-53.

  10. Lubitz SA, Yin X, Fontes JD, Magnani JW, Rienstra M, Pai M, et al. Association between familial atrial fibrillation and risk of new-onset atrial fibrillation. JAMA. 2010;304(20):2263-9.

  11. Ellinor PT, Lunetta KL, Albert CM, Glazer NL, Ritchie MD, Smith AV, et al. Meta-analysis identifies six new susceptibility loci for atrial fibrillation. Nat Genet. 2012;44(6):670-5.

  12. McCallum CJ, Raja DC, Pathak RK. Atrial fibrillation: an update on management. Aust Prescr. 2019;42(6):186-91.

  13. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al.; ESC Scientific Document Group. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-962.

  14. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation. 2019;140(2):e125-51.

  15. Magalhães LP, Figueiredo MJO, Cintra FD, Saad EB, Kuniyishi RR, Teixeira RA, et al. II Diretrizes Brasileiras de Fibrilação Atrial. Arq Bras Cardiol. 2016;106(4 Supl 2):1-22.

  16. Potpara TS, Polovina MM, Licina MM, Marinkovic JM, Prostran MS, Lip GY. Reliable identification of “truly low” thromboembolic risk in patients initially diagnosed with “lone” atrial fibrillation: the Belgrade Atrial Fibrillation Study. Circ Arrhythm Electrophysiol. 2012;5(2):319-26.

  17. Lok NS, Lau CP. Presentation and management of patients admitted with atrial fibrillation: A review of 291 cases in a regional hospital. Int J Cardiol. 1995;48(3):271-8.

  18. Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians EvidenceBased Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):160S98S.

  19. Connolly SJ, Ezekowitz MD, Yusuf S, Eikelboom J, Oldgren J, Parekh A, et al.; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-51.

  20. Lip GY, Clemens A, Noack H, Ferreira J, Connolly SJ, Yusuf S. Patient outcomes using the European label for dabigatran. A post-hoc analysis from the RE-LY database. Thromb Haemost. 2014;111(5):933-42.

  21. Pollack CV Jr, Reilly PA, van Ryn J, Eikelboom JW, Glund S, Bernstein RA, et al. Idarucizumab for dabigatran reversal – Full Cohort Analysis. N Engl J Med. 2017;377(5):431-41.

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