- Kathryn E Griffith, general practitioner1,
- Maurice Pye, consultant cardiologist2
- 1University Health Centre, York University, York YO10 5DD
- 2York Hospital, York
- Correspondence to: K Griffith
A 63 year old man sees your practice nurse for a routine blood pressure check. He has had hypertension for five years and is taking ramipril 10 mg, bendroflumethiazide 2.5 mg, and atenolol 25 mg daily. He has no past history of ischaemic heart disease, stroke, or diabetes. The nurse’s electronic sphygmomanometer is unable to produce a recording, and she asks for your advice. You find his pulse to be intermittently irregular.
What issues you should cover
Atrial fibrillation is a recognised cause of error in blood pressure measurement. When atrial fibrillation is an incidental finding and thus asymptomatic, it may be difficult to decide whether it is paroxysmal, persistent, or permanent.
It is important to reach a diagnosis and arrange electrocardiography as soon as possible and to confirm that he has not had an embolic event, particularly a transient ischaemic attack (TIA) with sudden onset of reversible neurological deficit.
Atrial fibrillation can result in symptoms related to abnormal cardiac rate and output or in cerebrovascular symptoms caused by thromboemboli.