Difference between revisions of "Multifocal atrial tachycardia"

Line 28: Line 28:
 
{{Palpitations DDX}}
 
{{Palpitations DDX}}
  
==Workup==
+
==Diagnosis==
 
*[[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 level
 
*Magnesium level

Revision as of 20:30, 26 February 2016

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

  • Palpitations
  • Dyspnea
  • Chest pain
  • Presyncope/syncope
Multifocal atrial tachycardia

Differential Diagnosis

Palpitations

Diagnosis

  • ECG
    • Irregular tachycardia (>100 bpm)
    • At least 3 distinct p wave morphologies
    • No dominant pacemaker site
  • BMP
  • Magnesium level
  • Hb/Hct
  • Consider infectious disease w/u
  • Consider ABG/VBG

Management

  • Treat the 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 BB/CCB in hemodynamically stable patient (caution with pulmonary disease)
  • Cardioversion not definitive, likely recurrence if underlying illness not addressed

Disposition

  • Disposition depends on the underlying illness, but often requires admission due to illness severity/age
  • Poor prognostic sign when developed during hospitalization/illness
    • 60% in hospital mortality
    • mean survival around 1 year
    • Due to illness not arrhythmia

See Also

External Links

Sources