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ECG Abnormalities_Part 20

Monday, June 25, 2012

A 65 year old male patient with end-stage COPD gets admitted to the ICU with respiratory failure. He was found to have the below ECG:

What are the ECG findings?
What is the treatment for this heart rhythm disorder?

ANSWER

The ECG findings include: 1) Multifocal atrial tachycardia (three distinct P wave morphologies) 2) Incomplete right bundle branch block 3) Poor R wave progression 4) PVCs

Multifocal atrial tachycardia (aka MAT) is an irregularly irregular, tachycaric rhythm in which many foci in the atium chaotically fire acting as the pacemaker of the heart instead of the sinus node. The atrial rate is not as fast as in atrial flutter or atrial fibrillation, so normal AV synchrony can occur. When the rhythm has 3 distinct P wave morphologies and the heart rate is not fast, the term "wandering atrial pacemaker" or WAP is used.

 The treatment of multifocal atrial tachycardia is aimed at the underlying cause. In this case it would be to treat the COPD exacerbation and respiratory failure. The only medication that has been used to treat MAT is verapamil with only marginal success. No anticoagulation is needed for MAT in contrast to atrial flutter/fibrillation since the atrium are contracting well, but simply originating in different areas.


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5 Responses to ECG Abnormalities_Part 20

  1. Anonymous Says:
  2. Multifocal atrial tachycardia

    Treatment for MAT includes:

    Methods to improve blood oxygen levels
    Magnesium given through a vein
    Stopping medications, such as theophylline, which can increase the heart rate
    Medicines to control the heart rate, such as calcium channel blockers (verapamil, diltiazem) or certain beta-blockers

     
  3. Anonymous Says:
  4. Multi focal atrial tachycardia, secondary to hypoxia.

    TX: improve oxygenation.

     
  5. Anonymous Says:
  6. mutifocal atrial tachycardia

    treatment: oxygenation and verapamil ( calcium channel bloker)

     
  7. Anonymous Says:
  8. i guess he has a right branch bundle block.... verapamil will make it worse... oxygenation is enough and i think we should check for secondary polycythymia.....

     
  9. I don’t know how should I give you thanks! I am totally stunned by your article. You saved my time. Thanks a million for sharing this article.

     

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