Multifocal atrial tachycardia: Difference between revisions
| Line 39: | Line 39: | ||
==Management== | ==Management== | ||
*Treat | *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 | **Can consider beta-blocker or calcium channel blocker in hemodynamically stable patient | ||
*Cardioversion not definitive | ***Use beta-blockers cautiously in patients with pulmonary disease | ||
*Cardioversion not definitive | |||
**MAT likely to recur if underlying etiology not addressed | |||
==Disposition== | ==Disposition== | ||
Revision as of 21:57, 12 March 2019
Background
- Multiple (3 or more) ectopic foci in the atria causing an irregular atrial tachycardia
- Increased automaticity due to causes listed below
Causes
- COPD
- CHF
- Sepsis
- Methylxanthine toxicity / Theophylline toxicity
- Electrolyte abnormalities
- Other associations
- Valvular heart disease
- DM
- Acute renal failure
- Postoperative state
- Pulmonary embolism
- Pneumonia
- Anemia
Clinical Features
- Palpitations
- Dyspnea
- Chest pain
- Presyncope/syncope
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
- 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
- Treat 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 beta-blocker or calcium channel blocker in hemodynamically stable patient
- Use beta-blockers cautiously in patients with pulmonary disease
- Cardioversion not definitive
- MAT likely to recur if underlying etiology not addressed
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
- 60% in-hospital mortality