Heart Health Heart Disease Atrial Fibrillation Atrial Fibrillation Guide Atrial Fibrillation Guide Symptoms Causes Diagnosis Treatment Coping Symptoms of Atrial Fibrillation By Richard N. Fogoros, MD Richard N. Fogoros, MD Facebook LinkedIn Richard N. Fogoros, MD, is a retired professor of medicine and board-certified internal medicine physician and cardiologist. Learn about our editorial process Updated on September 09, 2021 Medically reviewed by Richard N. Fogoros, MD Medically reviewed by Richard N. Fogoros, MD Facebook LinkedIn Richard N. Fogoros, MD, is a retired professor of medicine and board-certified internal medicine physician and cardiologist. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents Frequent Symptoms Rare Symptoms Complications/Sub-Group Indications When to See the Healthcare Provider or Go to the Hospital Frequently Asked Questions Next in Atrial Fibrillation Guide Causes and Risk Factors of Atrial Fibrillation The symptoms of atrial fibrillation can vary a lot from person to person, and even in the same person at different times. Palpitations are the most frequent symptom. While atrial fibrillation itself is not a life-threatening arrhythmia, it can lead to complications—in particular, stroke—that can be disabling or fatal. In most cases, at least before it is adequately treated, atrial fibrillation is a great annoyance, if not downright distressing and intolerable. Verywell / Nusha Ashjaee Frequent Symptoms The most common symptoms of atrial fibrillation are: PalpitationsEasy fatiguabilityShortness of breathChest discomfortEpisodes of lightheadedness Palpitations Palpitations are most frequently associated with atrial fibrillation. These are unusual and uncomfortable moments of awareness of one's heartbeat. In atrial fibrillation, palpitations are caused by the rapid, irregular heart rate that is commonly seen with this arrhythmia. People who experience palpitations with atrial fibrillation usually complain of the sensation of a “fluttering” in the chest, often accompanied by a feeling of “skipped” beats, and occasionally by brief episodes of lightheadedness. Palpitations associated with atrial fibrillation might be only mildly irritating, but they could also be extremely disturbing. Their severity can wax and wane. In some, the severity of the palpitations may depend on their emotional state, whether they’re sitting or lying down, their state of hydration, whether or not they are sleep deprived, and several other factors related to daily life. Most of the time, however, no particular associations can be identified. Palpitations are usually greatly diminished and often eliminated when the heart rate during atrial fibrillation is slowed with medications—a goal that can usually be accomplished quite readily. What Are Heart Palpitations? Atrial Contraction-Related Symptoms Also common with atrial fibrillation are reduced exercise tolerance, fatigue, dyspnea (shortness of breath), and even lightheadedness with almost any level of exertion. These symptoms are usually associated with the loss of cardiac efficiency that occurs when the atrial chambers are no longer able to beat effectively. When atrial contraction is lost, the amount of blood the ventricles are able to eject with each heartbeat may become diminished. This limited cardiac output reduces a person’s exercise tolerance. Furthermore, when the atrial chambers stop beating effectively, the blood tends to “back up” into the lungs, producing shortness of breath. In many people with atrial fibrillation, cardiac efficiency may be perfectly adequate at rest, but during exertion, when the heart is pushed to work harder, symptoms may become quite severe. Rare Symptoms Syncope, or an episode of loss of consciousness, is not common in atrial fibrillation. When syncope does occur, it is a strong clue that the patient may also have underlying sinus node disease, or sick sinus syndrome (SSS). A minority of people with atrial fibrillation have no symptoms at all, and the arrhythmia is discovered only when a healthcare provider or nurse takes their pulse or performs an electrocardiogram (ECG). Complications/Sub-Group Indications Symptoms caused by the loss of effective atrial contractions tend to be much more troublesome in people who, in addition to atrial fibrillation, have cardiac conditions in which the ventricles are relatively “stiff.” Stiff ventricles tend to be highly dependent on a strong atrial contraction in order to fill completely. When atrial contractions are lost in these patients, cardiac efficiency may drop very significantly. Conditions that tend to produce stiff ventricles include hypertrophic cardiomyopathy, diastolic dysfunction, aortic stenosis, and even chronic high blood pressure (hypertension). In people with these conditions, the onset of atrial fibrillation commonly produces symptoms that are particularly severe. Angina In people who have coronary artery disease, the rapid heart rate seen with atrial fibrillation can cause angina (chest discomfort). Sick Sinus Syndrome Sick sinus syndrome (SSS) is a generalized disorder of the heart’s electrical system manifested by a slow heart rate (bradycardia). The heart's natural pacemaker is the sinus node, an area of cells in right upper heart chamber (right atrium) where electrical signals are generated. The signals then travel to the rest of your heart muscle, signaling it to contract in rhythm. When there is damage or scarring to the heart, the electrical pathways from the sinus node may be disrupted, which leads to sick sinus syndrome. Atrial fibrillation is common in patients with SSS. In a way, atrial fibrillation “protects” patients with SSS because it generally results in a heart rate that is fast enough to thwart symptoms of bradycardia, such as lightheadedness and weakness. However, the atrial fibrillation often comes and goes periodically. When the arrhythmia suddenly stops, there is often a very long delay before the sick sinus node picks up again. That long pause before a heartbeat occurs is what produces syncope. Treating SSS requires the use of a permanent pacemaker. In people who have both SSS and atrial fibrillation, it is usually best to insert the pacemaker before aggressive steps are taken to treat the atrial fibrillation (because this treatment often causes the heart rate to slow). Heart Failure For those with heart failure, the additional reduction in cardiac efficiency brought on by atrial fibrillation can greatly worsen symptoms—chiefly, shortness of breath, weakness, and swelling in the legs. Rarely, atrial fibrillation can produce heart failure all by itself. Any arrhythmia that is capable of making the heartbeat very rapidly for several weeks or months can cause the heart muscle to weaken and lead to heart failure. Fortunately, this condition (tachycardia-induced heart failure) is a relatively rare consequence of atrial fibrillation. Stroke Atrial fibrillation raises your risk of stroke to five times the usual risk. The increased risk of stroke is the main reason that it is always important to carefully consider the optimal treatment for atrial fibrillation—even in cases where the condition is well-tolerated and seems to be causing no particular problems. Some people will have repeated episodes of atrial fibrillation without any symptoms whatsoever until they, at last, suffer a stroke. Only after the stroke occurs is it discovered that they are experiencing atrial fibrillation. Evidence suggests that “subclinical” atrial fibrillation is more common than experts had realized and that unrecognized atrial fibrillation may be an important cause of cryptogenic stroke—that is, a stroke without an immediately apparent cause. When to See the Healthcare Provider or Go to the Hospital Palpitations, easy fatiguability, shortness of breath, chest discomfort, and episodes of lightheadedness or passing out are symptoms that you should always mention to your healthcare provider. Be sure to also share details on what led to these symptoms. If you are having an episode of atrial fibrillation and your heart doesn't return to its normal rhythm in a few minutes, or your symptoms get worse, call your healthcare provider. Seek immediate emergency medical help for these symptoms of a heart attack or stroke:Pain or pressure in the middle of your chestFace droopingArm weaknessSpeech difficultySudden numbness, especially on one sideSudden severe headacheSudden vision problems in one or both eyesSudden loss of balance or trouble walking A Word From Verywell If you have atrial fibrillation, your healthcare provider will ask you about all of these symptoms before recommending next steps. Try to be as accurate and complete as you can when sharing your medical history. This will help your healthcare provider better diagnose your condition and pick a treatment plan that's right for you. The two goals in treating atrial fibrillation are to prevent stroke and to control symptoms so that you can live a normal life. Frequently Asked Questions What are common atrial fibrillation triggers? An episode may come on during stress—in fact, about half of people with atrial fibrillation say stress is their most common trigger. It can also be triggered by other factors, such as a medication, caffeine, alcohol, or smoking. Other conditions, including sleep apnea, high blood pressure, and COPD, can also raise the risk of having an episode. Does atrial fibrillation cause blood clots? Yes, it may. When the heart beats irregularly, blood can pool in the heart and clot there. As a result, blood clots may travel to the brain, causing a stroke. Blood clots can also block other arteries. 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J Arrhythm. 2017;34(1):1–3. doi:10.1002/joa3.12016 Hansson A, Madsen-Härdig B, Olsson SB. Arrhythmia-provoking factors and symptoms at the onset of paroxysmal atrial fibrillation: A study based on interviews with 100 patients seeking hospital assistance. BMC Cardiovasc Disord. 2004 Aug 3;4:13. doi:10.1186/1471-2261-4-13 Hald EM, Rinde LB, Lochen M-L, et al. Atrial fibrillation and cause-specific risks of pulmonary embolism and ischemic stroke. J Am Heart Assoc. 2018 Jan 29;7(3):e006502. doi:10.1161/JAHA.117.006502 Additional Reading American College of Cardiology Foundation, American Heart Association, European Society of Cardiology, et al. Management of Patients with Atrial Fibrillation (Compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS Recommendations): a Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127:1916. doi:10.1161/CIR.0b013e318290826d January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation 2019. doi:10.1161/CIR.0000000000000665 By Richard N. Fogoros, MD Richard N. Fogoros, MD, is a retired professor of medicine and board-certified in internal medicine, clinical cardiology, and clinical electrophysiology. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit