A 41 YEAR OLD FEMALE CAME WITH C/O
PALPITATION FOR A DURATION OF 3 DAYS
PATIENT WAS APPARENTLY NORMAL 3 DAYS BACK,STARTED
DEVELOPING BREATHLESSNESS INITIALLY ON EXERTION NOW AT
REST.H/O OF ORTHOPNEA PRESENT.H/O CHEST PAIN PRESENT.
PAST H/O:H/O OF SURGERY DONE FOR VALVULAR HEART
DISEASE 14 YEARS BACK.
PATIENT HAS NOT BEEN TAKING MEDICATIONS FOR PAST 1
Low amplitude baseline oscillations and an irregularly
irregular ventricular rhythm.
The f waves have a rate of 300 to 600 beats /min.
Variable in shape,amplitude and timing.
Distingushing feature from flutter is absence of
uniform and regular atrial activity in other laeds of
chaotic atrial depolarization
the atria contract irregularly and very rapidly
producing variable R-R intervals
no regular p waves are identifiable and the baseline
Wandering atrial pacemaker
The electrical impulse is generated at a
different focus within the atria of the heart
Decompensated chronic lung disease
Congestive heart failure
1. TREATMENT OF UNDERLYING CAUSE
2. ANTIARRYTHMICS OFTEN INEFFECTIVE
3. VERAPAMIL OR AMIODARONE HAVE BEEN USEFUL
4. POTTASIUM AND MAGNESIUM REPLACEMNT
5. ABLATION USEFUL IN SOME CASES.
•DISCRETE P WAVES WITH AT LEAST 3 DIFFERENT
• ABSENCE OF ONE DOMINANT ATRIAL PACEMAKER
• ATRIAL RATE BETWEEN 100 AND 130.
• THE PP, PR, AND RR INTERVALS ALL VARY.
•LEFT ATRIAL ENLARGEMENT
•RIGHT QRS AXIS DEVIATION
•A WIDE FRONTAL PLANE QRS-T ANGLE
•A PRECORDIAL MORPHOLOGY WHICH MAY MANIFEST ANY ONE OF
THE FOLLOWING FEATURES
A RELATIVELY NORMAL,NEUTRAL OR UNREMARKABLE
RIGHT VENTRICULAR SYSTOLIC OVERLOAD
RIGHT VENTRICULAR DIASTOLIC OVERLOAD