Premature atrial contraction: Difference between revisions
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==Background== | ==Background== | ||
Premature atrial contractions (PACs) are common and typically benign premature beats characterized by an abnormal early P wave within a cardiac cycle. Less commonly, they can precipitate [[atrial fibrillation]], [[atrial flutter]], or [[SVT]].<ref>Specific dysryhthmias. In: Marx K, Rosen P, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier/Saunders, 2014.</ref> | |||
==Clinical Features== | ==Clinical Features== | ||
*Palpitations | |||
*Shortness of breath | |||
*Anxiety | |||
*Asymptomatic | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*Obtain EKG and look for: | |||
**P waves that appear sooner than expected sinus beat | |||
**Ectopic P waves that have different morphology | |||
**Interval between normal P waves encompassing the PAC is less than twice the existing P-P cycle length (noncompensatory pause)<ref>Brady W, Laughrey T, Ghaemmaghami C. Cardiac rhythm disturbances. In Tintinalli's Emergency Medicine: A Comprehensive Guide. Tintinalli J, et al. ed. 8th ed. McGraw Hill. New York, NY, 2016.</ref> | |||
[[File:PAC.png|frame|EKG showing PACs]] | |||
*Rule out underlying conditions: | |||
**Chronic heart disease (increases prevalence of PACs) | |||
**Chronic lung disease (increases prevalence of PACs) | |||
**Drugs: cocaine, amphetamines, caffeine, nicotine, digoxin | |||
==Management== | ==Management== | ||
*No specific treatment necessary | |||
*If symptomatic, treat underlying disorder or discontinue offending agent. | |||
==Disposition== | ==Disposition== | ||
*Discharge home, no specific follow-up (unless identifiable underlying etiology that needs to be treated). | |||
==See Also== | ==See Also== | ||
*[[Palpitations]] | |||
*[[Premature ventricular contraction]] | |||
*[[Premature junctional contraction]] | |||
==External Links== | ==External Links== | ||
Latest revision as of 21:05, 24 March 2020
Background
Premature atrial contractions (PACs) are common and typically benign premature beats characterized by an abnormal early P wave within a cardiac cycle. Less commonly, they can precipitate atrial fibrillation, atrial flutter, or SVT.[1]
Clinical Features
- Palpitations
- Shortness of breath
- Anxiety
- Asymptomatic
Differential Diagnosis
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
- Obtain EKG and look for:
- P waves that appear sooner than expected sinus beat
- Ectopic P waves that have different morphology
- Interval between normal P waves encompassing the PAC is less than twice the existing P-P cycle length (noncompensatory pause)[2]
EKG showing PACs
- Rule out underlying conditions:
- Chronic heart disease (increases prevalence of PACs)
- Chronic lung disease (increases prevalence of PACs)
- Drugs: cocaine, amphetamines, caffeine, nicotine, digoxin
Management
- No specific treatment necessary
- If symptomatic, treat underlying disorder or discontinue offending agent.
Disposition
- Discharge home, no specific follow-up (unless identifiable underlying etiology that needs to be treated).
See Also
External Links
References
- ↑ Specific dysryhthmias. In: Marx K, Rosen P, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier/Saunders, 2014.
- ↑ Brady W, Laughrey T, Ghaemmaghami C. Cardiac rhythm disturbances. In Tintinalli's Emergency Medicine: A Comprehensive Guide. Tintinalli J, et al. ed. 8th ed. McGraw Hill. New York, NY, 2016.