Difference between revisions of "Multifocal atrial tachycardia"

 
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*[[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}}
  
==Diagnosis==
+
==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
*Magnesium level
+
*Hemoglobin/hematocrit
*Hb/Hct
+
*Consider infectious disease work up
*Consider infectious disease w/u
+
*Consider [[ABG]]/[[VBG]]
*Consider ABG/VBG
 
  
 
==Management==
 
==Management==
*Treat the underlying cause
+
*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 BB/CCB in hemodynamically stable patient (caution with pulmonary disease)
+
**Can consider [[beta-blocker]] or [[calcium channel blocker]] in hemodynamically stable patient
*Cardioversion not definitive, likely recurrence if underlying illness not addressed
+
***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 the underlying illness, but often requires admission due to illness severity/age
+
*Disposition depends on underlying illness, but often requires admission due to illness severity
*Poor prognostic sign when developed during hospitalization/illness
+
*Poor prognostic sign when MAT develops during hospitalization or acute illness
**60% in hospital mortality
+
**60% in-hospital mortality
**mean survival around 1 year
+
***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==
  
==Sources==
+
==References==
*Rosen's
 
*Burns, E. Multifocal Atrial Tachycardia [Web log post]. Retrieved April, 29, 2015, from http://lifeinthefastlane.com
 
*Tandon N et al. Multifocal Atrial Tachycardia Overview of Multifocal Atrial Tachycardia. eMedicine. Dec 3, 2015. http://emedicine.medscape.com/article/155825-overview#showall
 
 
<references/>
 
<references/>
  
[[Category:Cards]]
+
[[Category:Cardiology]]

Latest 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

Clinical Features

Multifocal atrial tachycardia

Differential Diagnosis

Narrow-complex tachycardia

Palpitations

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

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

See Also

External Links

References