Multifocal atrial tachycardia: Difference between revisions
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*[[CHF]] | *[[CHF]] | ||
*[[Sepsis]] | *[[Sepsis]] | ||
*Methylxanthine toxicity | *Methylxanthine toxicity / [[Theophylline toxicity]] | ||
*Electrolyte abnormalities | *[[Electrolyte abnormalities]] | ||
*Other associations | |||
**Valvular heart disease | |||
**[[DM]] | |||
**[[Acute renal failure]] | |||
**Postoperative state | |||
**[[Pulmonary embolism]] | |||
**[[Pneumonia]] | |||
**[[Anemia]] | |||
==Clinical Features== | ==Clinical Features== | ||
*[[Palpitations]] | |||
*[[Dyspnea]] | |||
*[[Chest pain]] | |||
*Presyncope/[[syncope]] | |||
[[File:Multifocal atrial tachycardia - MAT.png|thumb|Multifocal atrial tachycardia]] | [[File:Multifocal atrial tachycardia - MAT.png|thumb|Multifocal atrial tachycardia]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Tachycardia (narrow) DDX}} | |||
{{Palpitations DDX}} | {{Palpitations DDX}} | ||
== | ==Evaluation== | ||
*[[ECG]] | *[[ECG]] | ||
*Irregular tachycardia (>100 bpm) | **Irregular tachycardia (>100 bpm) | ||
*At least 3 distinct p wave morphologies | **At least 3 distinct p wave morphologies | ||
*No dominant pacemaker site | **No dominant pacemaker site | ||
*BMP | *BMP, Magnesium | ||
* | *Hemoglobin/hematocrit | ||
*Consider infectious disease work up | |||
*Consider [[ABG]]/[[VBG]] | |||
==Management== | ==Management== | ||
*Treat | *Treat underlying cause | ||
*Replace magnesium | *Replace [[magnesium]] | ||
*Replace potassium | *Replace [[potassium]] | ||
*Increased AV nodal activity is unlikely to be effective | *Increased AV nodal activity is unlikely to be effective | ||
**Vagal maneuvers and adenosine may help reveal underlying rhythm/p-waves | **[[Vagal maneuvers]] and [[adenosine]] may help reveal underlying rhythm/p-waves | ||
**Can consider | **Can consider [[beta-blocker]] or [[calcium channel blocker]] in hemodynamically stable patient | ||
*Cardioversion not definitive | ***Use beta-blockers cautiously in patients with pulmonary disease | ||
*[[Cardioversion]] ''not'' definitive | |||
**MAT likely to recur if underlying etiology not addressed | |||
==Disposition== | ==Disposition== | ||
*Disposition depends on | *Disposition depends on underlying illness, but often requires admission due to illness severity | ||
*Poor prognostic sign when | *Poor prognostic sign when MAT develops during hospitalization or acute illness | ||
**60% in hospital mortality | **60% in-hospital mortality | ||
* | ***Due to illness, not arrhythmia | ||
**Due to illness not arrhythmia | **Mean survival around 1 year | ||
==See Also== | ==See Also== | ||
| Line 44: | Line 61: | ||
==External Links== | ==External Links== | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Cardiology]] | ||
Revision as of 15:46, 25 September 2019
Background
- Multiple (3 or more) ectopic foci in the atria causing an irregular atrial tachycardia
- Increased automaticity due to causes listed below
Causes
- COPD
- CHF
- Sepsis
- Methylxanthine toxicity / Theophylline toxicity
- Electrolyte abnormalities
- Other associations
- Valvular heart disease
- DM
- Acute renal failure
- Postoperative state
- Pulmonary embolism
- Pneumonia
- Anemia
Clinical Features
- Palpitations
- Dyspnea
- Chest pain
- Presyncope/syncope
Differential Diagnosis
Narrow-complex tachycardia
- Regular
- AV Node Independent
- Sinus tachycardia
- Atrial tachycardia (uni-focal or multi-focal)
- Atrial fibrillation
- Atrial flutter
- Idiopathic fascicular left ventricular tachycardia
- AV Node Dependent
- AV Node Independent
- Irregular
- Multifocal atrial tachycardia (MAT)
- Sinus tachycardia with frequent PACs, PJCs, PVCs
- Atrial fibrillation
- Atrial flutter with variable conduction
- Digoxin Toxicity
Palpitations
- Arrhythmias:
- Non-arrhythmic cardiac causes:
- Psychiatric causes:
- Drugs and Medications:
- Alcohol
- Caffeine
- Drugs of abuse (e.g. cocaine)
- Medications (e.g. digoxin, theophylline)
- Tobacco
- Misc
Evaluation
- ECG
- Irregular tachycardia (>100 bpm)
- At least 3 distinct p wave morphologies
- No dominant pacemaker site
- BMP, Magnesium
- Hemoglobin/hematocrit
- Consider infectious disease work up
- Consider ABG/VBG
Management
- Treat underlying cause
- Replace magnesium
- Replace potassium
- Increased AV nodal activity is unlikely to be effective
- Vagal maneuvers and adenosine may help reveal underlying rhythm/p-waves
- Can consider beta-blocker or calcium channel blocker in hemodynamically stable patient
- Use beta-blockers cautiously in patients with pulmonary disease
- Cardioversion not definitive
- MAT likely to recur if underlying etiology not addressed
Disposition
- Disposition depends on underlying illness, but often requires admission due to illness severity
- Poor prognostic sign when MAT develops during hospitalization or acute illness
- 60% in-hospital mortality
- Due to illness, not arrhythmia
- Mean survival around 1 year
- 60% in-hospital mortality