Diagnosis

Primary aldosteronism: autonomous aldosterone excess drives sodium retention and renal potassium wasting.

Headache, diaphoresis, and palpitations/tachycardia from episodic catecholamine release.

Altered pain perception (e.g., autonomic neuropathy in diabetes, aging) leads to anginal equivalents: dyspnea, fatigue, nausea, epigastric or jaw discomfort, or confusion in the elderly.

HFrEF: EF ≤40% with impaired contractility (systolic dysfunction). HFpEF: EF ≥50% with a stiff ventricle and impaired relaxation (diastolic dysfunction), typically older women with hypertension, obesity, diabetes, or AF.

ACC/AHA stages (A at risk, B structural disease without symptoms, C symptomatic, D advanced/refractory) describe progression and do not move backward; NYHA classes I–IV describe symptom-limited activity and can improve or worsen.

Loss of organized atrial contraction causes blood stasis, especially in the left atrial appendage, forming thrombi that embolize to the brain. The pulse is irregularly irregular.