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ECG: Multifocal Atrial Tachycardia

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ECG: Multifocal Atrial Tachycardia

  1. 1. Prof.G.Sundaramurthy’s unit m7 Dr.K.Bhargavi
  2. 2. <ul><li>62 yr old male </li></ul><ul><li>Smoker </li></ul><ul><li>K/C/O COPD,CAD,SHT </li></ul><ul><li>c/o-palpitations,respiratory distress, giddiness </li></ul><ul><li>Pale,b/l pedal edema </li></ul><ul><li>PR-90/min; BP-110/70 mm Hg </li></ul><ul><li>Cvs-S1S2 + ; Rs- b/l crepts </li></ul>
  3. 5. <ul><li>12 lead ecg showing </li></ul><ul><li>Rate > 100 </li></ul><ul><li>Rhythm-irregular </li></ul><ul><li>P waves of >3 different morphologies </li></ul><ul><li>Varying P-P,P-R,R-R intervals </li></ul><ul><li>LVH pattern </li></ul><ul><li>PRWP V1 – V3. </li></ul><ul><ul><ul><ul><ul><li>MULTIFOCAL ATRIAL TACHYCARDIA </li></ul></ul></ul></ul></ul>
  4. 6. <ul><li>Cardiac arrythmia </li></ul><ul><li>Wandering atrial pacemaker </li></ul><ul><li>The electrical impulse is generated at a different focus within the atria of the heart each time. </li></ul>
  5. 7. <ul><li>Decompensated chronic lung disease </li></ul><ul><li>Congestive heart failure </li></ul><ul><li>Sepsis </li></ul><ul><li>Myocardial infarction </li></ul><ul><li>Pneumonia </li></ul><ul><li>Pulmonary embolism </li></ul><ul><li>Hypokalemia </li></ul><ul><li>Methylxanthine toxicity </li></ul>
  6. 8. <ul><ul><li>Palpitations </li></ul></ul><ul><ul><li>Shortness of breath </li></ul></ul><ul><ul><li>Chest pain </li></ul></ul><ul><ul><li>Lightheadedness </li></ul></ul><ul><ul><li>Syncopal episodes </li></ul></ul>
  7. 9. ECG Characteristics: Discrete P waves with at least 3different morphologies. Absence of one dominant atrial pacemaker Atrial rate > 100 bpm. The PP, PR, and RR intervals all vary.
  8. 10. <ul><li>Antiarrhythmics </li></ul><ul><li>verapamil </li></ul><ul><li>Magnesium sulfate </li></ul><ul><li>potassium </li></ul>
  9. 11. <ul><li>Other atrial arrhythmias </li></ul>
  10. 12. <ul><li>atrial rate of 250-350 bpm </li></ul><ul><li>large reentrant circuit </li></ul><ul><li>Negative sawtooth flutter waves in leads II, III, and AVF. AV conduction most commonly is 2:1, which yields a ventricular rate of approximately 150 bpm </li></ul><ul><li>ischemic heart disease, myocardial infarction, cardiomyopathy, myocarditis, pulmonary embolus or chest trauma </li></ul>
  11. 14. <ul><li>chaotic atrial depolarization </li></ul><ul><li>The atria contract irregularly and very rapidly producing variable R-R intervals </li></ul><ul><li>No regular P waves are identifiable and the baseline is undulating. </li></ul><ul><li>rheumatic heart disease, hypertension, ischemic heart disease, pericarditis, thyrotoxicosis, alcohol intoxication, mitral valve prolapse, and digitalis toxicity </li></ul>
  12. 16. <ul><li>Irregular rhythm. </li></ul><ul><li>P waves change shape as pacemaker location varies. </li></ul><ul><li>Rate under 100/minute </li></ul><ul><li>QRS- NORMAL </li></ul><ul><li>PSVT </li></ul>
  13. 17. <ul><li>Same as P.A.T. but only every second (or more) P’ wave produces a QRS. </li></ul>
  14. 19. <ul><li>P wave usually have a different morphology than sinus P waves because they originate from an ectopic pacemaker </li></ul><ul><li>QRS normal </li></ul><ul><li>Conduction normal, however the ectopic beats may have a different P-R interval. </li></ul><ul><li>Rhythm PAC's occur early in the cycle and they usually do not have a complete compensatory pause. </li></ul>
  15. 21. <ul><li>a pause in the normal cardiac rhythm due to a momentary failure of the sinus node to initiate an impulse, lasting for an interval that is not an exact multiple of the normal cardiac cycle. </li></ul>
  16. 23. THANK YOU

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