Dr. John Day, Cardiologist

What Are the Atrial Fibrillation Symptoms?

Many people wonder if they might have atrial fibrillation.  Short of doing an EKG, recognizing the symptoms can help you to determine if it is atrial fibrillation or not.  In this article, I’ll cover the key atrial fibrillation symptoms to look out for.

Bob’s Story

At 56, Bob thought he was getting old. While he never was the “exercising type,” he always prided himself on being able to do a hard day of work. Bob was a carpenter. He liked his work so much that he often joked that he wanted to keep hammering nails right up until one was nailed in his own coffin.

“Doc, I just don’t know what’s wrong with me. I can’t even make it through a day of work anymore. I’m just so tired and short of breath if I try to do anything. Is this old age?” He asked.

“You are too young to be tired and short of breath. I think it’s the atrial fibrillation,” I said.

“What can we do about it?” Bob asked.

“Let’s get your heart back in rhythm and see if you feel better,” I said.

With that, I had my nurse schedule him for an electrical cardioversion to shock his heart back into rhythm later that day. When he came back a month later, he looked a lot younger than his previous self.

“Doc, I feel young again,” he said.

“That’s sinus rhythm,” I said.

The Top 9 Atrial Fibrillation Symptoms

Having seen tens of thousands of patients with atrial fibrillation over my career, I think I have heard about every possible symptom there is.  Based on this experience, below are the top nine atrial fibrillation symptoms I hear from patients, in order.

1. No symptoms

Yes, you read this correctly.  No symptoms.

Indeed, if you ask an older or an inactive person with atrial fibrillation to describe their atrial fibrillation symptoms, they will probably tell you, “I don’t feel a thing.”

The reason for this is that if you aren’t regularly using your heart, then you probably won’t notice if your heart goes out of rhythm.  Even in people who swear they can tell the second they go out of rhythm, if you monitor them long enough you will discover they often have short atrial fibrillation attacks that they can’t feel.

Basically, the more you use your heart, the more likely you will be to notice that something isn’t right if your heart goes out of rhythm.

2. Fatigue

Of all the atrial fibrillation symptoms I hear, the most common is fatigue. Like Bob, many people don’t feel the palpitations or the rapid heartbeat.  Rather, they just are tired.  Many, like Bob, think that this fatigue is just a sign that they are getting old.

Remarkably, most patients feel much younger once we get their hearts back into normal rhythm. It’s almost like a switched was flipped.

There are so many reasons why atrial fibrillation patients feel tired.  To understand the five main reasons why people with atrial fibrillation feel so tired, here is a link to an article I wrote on this topic.

3. Shortness of Breath

After fatigue, the next most common atrial fibrillation symptom is shortness of breath.  The shortness of breath that comes from atrial fibrillation isn’t usually noticeable at rest.  Instead, it is a shortness of breath that comes from exertion.

For example, Bob’s breathing was fine when he was with me in the clinic.  However, as soon as he tried to do any physical work he felt breathless.

4. Palpitations

When most of my patients think about atrial fibrillation symptoms, palpitations immediately comes to mind.  But this isn’t the case.  In fact, many of my patients are amazed that they don’t feel anything in their chest when their heart is out of rhythm.  In Bob’s situation, because he never felt the palpitations, he didn’t think it could be his heart.

For those who can feel their atrial fibrillation symptoms, palpitations are the sensation that their heart is flopping around like a fish inside their chest. Sometimes, people may even describe “hard” or “pounding” beats with atrial fibrillation.

5. Chest Pain

Chest pain is an especially troublesome symptom to diagnose. With chest discomfort, it can be hard to tell if it is from atrial fibrillation or a heart attack.  Heck, it could even be one of a hundred other different causes.

One way that can help to determine if the cause is from atrial fibrillation has to do with the timing of the symptoms.  If you only have chest pain when your heart is in atrial fibrillation, then it is probably from the atrial fibrillation.  Indeed, if your chest pain instantaneously goes away the exact second your heart goes back to a normal rhythm then this is usually the case.

If, however, the chest pain doesn’t 100% correlate to your atrial fibrillation then it is likely a different cause.  Regardless of the cause, chest pain can be a life-threatening symptom so call for help immediately.

6. Dizziness or Lightheadedness

With the rapid heartbeat that accompanies most cases of atrial fibrillation, many people feel dizzy or lightheaded.  Dizziness and lightheadedness can also come from atrial fibrillation dropping your blood pressure.

As with chest pain, there are a million different causes of dizziness and lightheadedness.  Thus, to correctly determine if dizziness and lightheadedness come from your atrial fibrillation then these symptoms should 100% correlate to your pulse.

7. Leg Swelling

In older or heavier people, leg swelling can be a symptom of atrial fibrillation. As people get older, particularly if they have been overweight or have had high blood pressure, the heart can get very stiff. Just like when you are trying to blow up a balloon at a birthday party, a stiff heart is hard to fill with blood.

When the heart doesn’t fill properly, fluid backs up and swelling occurs. This situation is worse when the heart goes out of rhythm. Thus, many of my older, overweight, or hypertensive patients know they are out of rhythm based on how much swelling they are getting in their legs.

8. Fainting

In rare cases, atrial fibrillation can cause fainting in older people.  This happens either from the heart going so fast that the blood pressure drops or from the heart briefly flat-lining when the atrial fibrillation stops and sinus rhythm returns.

9. Other Seemingly Unrelated Symptoms

With atrial fibrillation, just about any symptom is possible. For example, some of my patients report excessive urination when they are out of rhythm. Others describe digestive issues or abdominal discomfort when their hearts are out of rhythm.  The bottom line is that atrial fibrillation can cause many other seemingly unrelated symptoms.

Practical Tips

Regardless of your symptoms, make sure your cardiologist is aware of your symptoms. Whether or not you and your cardiologist decide to treat atrial fibrillation aggressively largely comes down to your symptoms.

Also, don’t rely on symptoms to tell you that you are in atrial fibrillation.  I have seen far too many patients in my career suffer strokes because they relied on their atrial fibrillation symptoms to tell them if they were in rhythm or not. Symptoms are never 100% reliable.

Learn to check your pulse every day.  If your pulse is fast or irregular, then you just might be in atrial fibrillation.