#269 The 5 Best Ways to Diagnose Atrial Fibrillation

The 5 Best Ways to Diagnose Atrial Fibrillation

Isn’t it frustrating when doctors can’t seem to figure out what is going wrong?  It can be that way with atrial fibrillation that comes and goes.  Atrial fibrillation never seems to happen in the doctor’s office.  In this article, I’ll teach you the five very best ways to diagnose atrial fibrillation.

Mary’s Experience

Mary’s heart never did its thing in the doctor’s office.  For years, she had palpitations and a rapid heart beat.  But it always behaved in the doctor’s office.

During the many years she suffered from palpitations and a rapid heartbeat, her doctors had ordered many tests.  These tests included electrocardiograms (EKGs) and even a 48-hour heart monitor.  And everything always came back normal.

Because her doctors could never find anything wrong with her heart, they diagnosed her with panic attacks. Under this assumption, her doctors then prescribed anxiety medications.  Despite this, she knew something was wrong with her heart even though her doctors didn’t believe her.

Does Atrial Fibrillation Come and Go?

The problem was that Mary had the kind of atrial fibrillation that comes and goes.  The medical term for this kind of atrial fibrillation is paroxysmal atrial fibrillation.

With paroxysmal atrial fibrillation, the heart periodically goes out of rhythm and then will self-correct.  For some strange reason, people suffering from paroxysmal atrial fibrillation always seem to be in normal rhythm when they are at the doctor’s office.

Finally, after years of suffering, the diagnosis was made.  Sadly, it took a stroke that left her unable to speak before the EKG finally showed atrial fibrillation.  Fortunately for Mary, she got to the emergency room in time so that they could quickly dissolve the atrial fibrillation blood clot and allow her to speak again.  While it can be hard to diagnose atrial fibrillation, it doesn’t have to be this way.

How do you know if you are having atrial fibrillation?

Mary knew she was experiencing some form of an arrhythmia.  Her heart would suddenly take off racing.  Then, it would abruptly stop.

Probably the main reason why it took so long to diagnose atrial fibrillation is that she never learned to check her pulse.  If she could have communicated to her doctors that her pulse was periodically fast and irregular, the diagnosis could have been made years earlier.

And that is how you know you are in atrial fibrillation.  Your pulse is fast and irregular.  While this method isn’t 100% accurate, in my practice it works 99% of the time.

The 5 Best Ways to Diagnose Atrial Fibrillation

To cut the possible diagnosis time of atrial fibrillation from years to days, here are my five best ways to diagnose atrial fibrillation.

1.  A Fast and Irregular Pulse

As mentioned above, all atrial fibrillation patients need to learn to track their pulse.  The easiest way is to just feel your pulse.

Your pulse should be regular.  Occasionally you might “skip” a beat, this is normal.  If every beat is irregular then it is probably atrial fibrillation.

Next, count the number of beats you have in 15 seconds and multiple by four.  This is your pulse.  Unless you are on medications to slow your heart down, most cases of atrial fibrillation have a heart rate faster than 100 beats per minute.

What should you do if you can’t feel your pulse?  If you can’t feel your pulse you could listen to your heart beats to see if it is fast and irregular with a five dollar stethoscope you can buy on Amazon.

If your hearing isn’t any good either, then you can buy a twenty dollar pulse oximeter on Amazon.  With a pulse oximeter you look at the blinking light to see if it is fast and irregular.

2. Do an EKG While Your Heart is Fibrillating

While detecting a fast and irregular pulse will get you 99% of the way to the diagnosis, to confirm things you will need an EKG.  The easiest way to do this is to get an EKG done while your heart is in atrial fibrillation.

To expedite this process, I often write a prescription for an EKG and give it to my patients.   This way, whenever the atrial fibrillation attacks, they can quickly run to the hospital, bypassing the emergency room, and getting an EKG done.

If your doctor hasn’t yet written you a prescription for an EKG, you could run to the nearest urgent care clinic or the emergency room.  If you tell them your pulse is fast and irregular they will quickly do an EKG for you.

3. Have Your Doctor Order an Event Monitor

For those people who have atrial fibrillation attacks that don’t occur frequently, and don’t last very long, an event monitor is a great way to go.  An event monitor is a heart monitor that you use at home.  Most models have several electrodes that you stick to your skin.

In my practice, I typically prescribe an event monitor for one month.  Also, the event monitor is continuously transmitting, like a cell phone, as people experience atrial fibrillation.  Thus, it may not take long to nail down the diagnosis.

4. Turn Your Smartphone into an EKG Machine

For those who don’t get atrial fibrillation attacks every month, turning your iPhone or Android phone into an EKG machine may be the way to go.  For this approach, you pay a one time $99 fee on the Alivecor website to buy some electrodes that bluetooth in to your phone.

With the KardiaMobile system, you can now email or text the EKGs from your phone.  These EKGs are no different from what you might get at the hospital so the diagnosis is usually pretty straightforward.

Unfortunately, the free “EKG apps” available for smartphone users are usually worthless when it comes to making the diagnosis.  These apps rely on the flash component of your phone to try and diagnose atrial fibrillation.  If you want to use your phone, then pay the $99 and get a high quality system.

5. Turn Your Apple Watch into an EKG Machine

If money is not an issue, and you want the coolest way to diagnose and track your atrial fibrillation, then go with the KardiaBand.  For $199, on top of the cost of buying the latest Apple Watch, as well as ten dollars a month in recurring expenses you can turn your Apple Watch into an EKG machine.  As with the smartphone version described above, you get a high quality EKG for your doctor.

Practical Tips

No one should have to wait years before atrial fibrillation is finally diagnosed.  Because atrial fibrillation can cause strokes, you don’t want any delay in making the correct diagnosis.

Of all the ways to diagnose atrial fibrillation, taking you pulse has to be the easiest.  If your pulse is fast (usually above 100 beats per minute if you aren’t on any heart medications) and irregular then you probably have atrial fibrillation.

To confirm the diagnosis, you will need an EKG.  Whether that EKG comes from the doctor’s office, an event monitor, your smart phone, or even your Apple Watch it really doesn’t matter.

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6 Comments
  1. HI Dr. Day : After 3 years , finally diagnosed with paroxysmal AFIB , although after researching I knew what was happening . Have maintained a medical journal and developed my own protocol . My profile is age 82 , male , WFPB diet , athlete all my life , weight 145 , BMI 21 and in good overall health except for AFIB . My experience shows that heavy exercise on successive days , whether in gym , walking or doing yard work and maintenance around house leads to sleeplessness and insomnia ( confounds the doctors as exercise is supposed to aid sleep ) which causes AFIB . Another contributing factor appears to be alcohol.

    Have had numerous tests run to rule out adrenal system , thyroid etc ,all negative . My protocol now consists of exercising every 2 nd day and practicing CBT for sleep to avoid AFIB . Based on a report of a clinical trial 100 patients by a cardiologist practice I do not take Eliquis daily but carry it with me in case of an incident . Interested to learn if the medical practitioners or patients know other causes or their particular experiences .

    • Hi Stephen,

      Thanks for reading and for reaching out!

      Yes, everyone may have their own unique Afib triggers. For many though, there are no apparent triggers.

      Alcohol is a well known Afib trigger. Exercise generally helps Afib but excessive exercise can be a trigger.

      Each week I will post a new article on Afib. Over the next year, I will share many possible Afib triggers and how people can optimize their lives in a way to avoid Afib episodes. Stay tuned…

      Best,

      John

    • I would be interested in knowing more about the clinical trial of 100 patients by a cardiologist that has allowed you to just carry Eliquis with you to avoid taking it daily.

      Thank you!

      • Hi Rachel,

        Me too! There have now been a few studies looking at blood thinners as needed for atrial fibrillation. The problem is that the low number of people in these studies makes it impossible to know if this approach is safe or not. To really find the answer you would need a study that included thousands and thousands of people. As you might imagine, doing a study involving thousands and thousands of patients would require tens of millions of dollars. As the drug companies want people to take their drug everyday, as opposed to just as needed, they would never spend this kind of money to do a study which could hurt their bottom line. My goal is that we can build this online atrial fibrillation community big enough that we could do this kind of a study in a non-traditional way that wouldn’t require such a massive budget…

        John

  2. Hi Dr. Day,

    I am taking Metoprolol (extended release) once a day, plus Eliquis twice a day. I’ve had two instances of diagnosed A-Fib in the past. I have also been diagnosed with having Premature Atrial Contractions (PAC). What is your advice for determining if I am having A-Fib?

    Thanks so much,

    Ellyn

    • Hi Ellyn,

      My favorite way to monitor Afib at home is to use the Alivecor Kardia monitor. This is the most accurate way to track things.

      I have taught many of my patients how they can learn to interpret their own EKG tracings using this device with a remarkable high degree of accuracy. As atrial fibrillation results in a fast and irregular rhythm for most people, if you know what you are looking for it is easy to see with this monitor. Sometimes, though, it can be tricky to tease out Afib from a lot of PACs.

      I have my patients track their rhythms using this device and then bring it with them to clinic. During their clinic visits we review their EKGs and it also allows me a chance to teach them how to interpret what they are seeing.

      Of course, there are cheaper ways to monitor Afib as well which are discussed in this article…

      John