A nurse is reinforcing teaching with a client who has symptomatic atrial fibrillation about manifestations they may experience. Which of the following manifestations should the nurse include? (Select All that Apply.)

Atrial fibrillation features rapid, uncoordinated atrial depolarizations that eliminate the mechanical atrial kick, reducing total cardiac output by up to 30 percent. The irregular ventricular response shortens diastolic filling time, rapidly elevating left atrial and pulmonary venous pressures. This hemodynamic impairment manifests primarily as exertional fatigue and acute shortness of breath due to decreased systemic perfusion and pulmonary congestion. A. Exertional fatigue: The loss of organized atrial contractions reduces stroke volume and limits the heart's ability to boost cardiac output during physical stress. Skeletal muscles experience rapid ATP depletion due to inadequate oxygen delivery, presenting as profound physical exhaustion. This represents a classic symptomatic consequence of the arrhythmia. B. Weight gain: Rapid fluctuations in body mass reflect systemic fluid retention seen in progressive right-sided heart failure or metabolic conditions. Isolated, symptomatic atrial fibrillation alters heart rate and rhythm dynamics but does not inherently drive fluid accumulation unless chronic cardiomyopathy develops. It is not an immediate symptom. C. Shortness of breath: Inefficient ventricular filling causes blood to back up into the pulmonary vasculature, increasing hydrostatic pressure within the alveolar capillaries. This fluid accumulation impairs gas exchange, triggering tachypnea and dyspnea during mild exertion or rest. It signals immediate hemodynamic back-pressure from the left atrium. D. Hiccups: Singultus results from involuntary diaphragmatic spasms mediated by phrenic nerve irritation or central nervous system triggers. There is no direct pathophysiological pathway connecting uncoordinated supraventricular tachyarrhythmias to the reflex arc controlling diaphragmatic contractions. It remains an unrelated gastrointestinal or neurological symptom. E. Difficulty swallowing: Dysphagia stems from structural esophageal obstructions, neuro-muscular incoordination, or cranial nerve lesions affecting the upper gastrointestinal tract. Atrial fibrillation alters the electrical conduction system of the heart and does not mechanically compromise the pharyngeal or esophageal phases of deglutition. It is anatomically distinct.