Multifocal atrial tachycardia: Difference between revisions
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*[[Sepsis]] | *[[Sepsis]] | ||
*Methylxanthine toxicity / [[Theophylline toxicity]] | *Methylxanthine toxicity / [[Theophylline toxicity]] | ||
*Electrolyte abnormalities | *[[Electrolyte abnormalities]] | ||
*Other associations | *Other associations | ||
**Valvular heart disease | **Valvular heart disease | ||
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==Clinical Features== | ==Clinical Features== | ||
*Palpitations | *[[Palpitations]] | ||
*Dyspnea | *[[Dyspnea]] | ||
*[[Chest pain]] | *[[Chest pain]] | ||
*Presyncope/syncope | *Presyncope/[[syncope]] | ||
[[File:Multifocal atrial tachycardia - MAT.png|thumb|Multifocal atrial tachycardia]] | [[File:Multifocal atrial tachycardia - MAT.png|thumb|Multifocal atrial tachycardia]] | ||
| Line 37: | Line 37: | ||
*Hemoglobin/hematocrit | *Hemoglobin/hematocrit | ||
*Consider infectious disease work up | *Consider infectious disease work up | ||
*Consider ABG/VBG | *Consider [[ABG]]/[[VBG]] | ||
==Management== | ==Management== | ||
*Treat underlying cause | *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 beta-blocker or calcium channel blocker in hemodynamically stable patient | **Can consider [[beta-blocker]] or [[calcium channel blocker]] in hemodynamically stable patient | ||
***Use beta-blockers cautiously in patients with pulmonary disease | ***Use beta-blockers cautiously in patients with pulmonary disease | ||
*Cardioversion not definitive | *[[Cardioversion]] ''not'' definitive | ||
**MAT likely to recur if underlying etiology not addressed | **MAT likely to recur if underlying etiology not addressed | ||
Revision as of 15:46, 25 September 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
Narrow-complex tachycardia
- Regular
- AV Node Independent
- Sinus tachycardia
- Atrial tachycardia (uni-focal or multi-focal)
- Atrial fibrillation
- Atrial flutter
- Idiopathic fascicular left ventricular tachycardia
- AV Node Dependent
- AV Node Independent
- Irregular
- Multifocal atrial tachycardia (MAT)
- Sinus tachycardia with frequent PACs, PJCs, PVCs
- Atrial fibrillation
- Atrial flutter with variable conduction
- Digoxin Toxicity
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