Difference between revisions of "Multifocal atrial tachycardia"
ClaireLewis (talk | contribs) |
|||
| (14 intermediate revisions by 6 users not shown) | |||
| Line 7: | Line 7: | ||
*[[CHF]] | *[[CHF]] | ||
*[[Sepsis]] | *[[Sepsis]] | ||
| − | *Methylxanthine toxicity | + | *Methylxanthine toxicity / [[Theophylline toxicity]] |
| − | *Electrolyte abnormalities | + | *[[Electrolyte abnormalities]] |
*Other associations | *Other associations | ||
**Valvular heart disease | **Valvular heart disease | ||
| Line 19: | Line 19: | ||
==Clinical Features== | ==Clinical Features== | ||
| − | *Palpitations | + | *[[Palpitations]] |
| − | *Dyspnea | + | *[[Dyspnea]] |
| − | *Chest pain | + | *[[Chest pain]] |
| − | *Presyncope/syncope | + | *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 infectious disease | + | *Consider [[ABG]]/[[VBG]] |
| − | *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 59: | Line 61: | ||
==External Links== | ==External Links== | ||
| − | == | + | ==References== |
| − | |||
| − | |||
| − | |||
<references/> | <references/> | ||
| − | [[Category: | + | [[Category:Cardiology]] |
Latest revision as of 15:46, 25 September 2019
Contents
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
- AV Node Dependent
- AV Node Independent
- Irregular
- Multifocal atrial tachycardia (MAT)
- Sinus tachycardia with frequent PACs
- Atrial fibrillation
- Atrial flutter with variable conduction
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