ECG: Multifocal Atrial Tachycardia

1. Prof.G.Sundaramurthy’s
unit m7
Dr.K.Bhargavi

2. 62 yr old male
Smoker
K/C/O COPD,CAD,SHT
c/o-palpitations,respiratory distress,
giddiness
Pale,b/l pedal edema
PR-90/min; BP-110/70 mm Hg
Cvs-S1S2 + ; Rs- b/l crepts

5. 12 lead ecg showing
Rate > 100
Rhythm-irregular
P waves of >3 different morphologies
Varying P-P,P-R,R-R intervals
LVH pattern
PRWP V1 – V3.
MULTIFOCAL ATRIAL
TACHYCARDIA

6. Cardiac arrythmia
Wandering atrial pacemaker
The electrical impulse is generated at a
different focus within the atria of the heart
each time.

7. Decompensated chronic lung disease
Congestive heart failure
Sepsis
Myocardial infarction
Pneumonia
Pulmonary embolism
Hypokalemia
Methylxanthine toxicity

8. Palpitations
Shortness of breath
Chest pain
Lightheadedness
Syncopal episodes

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.

10. Antiarrhythmics
verapamil
Magnesium sulfate
potassium

11. Other atrial arrhythmias

12. atrial rate of 250-350 bpm
large reentrant circuit
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
ischemic heart disease, myocardial infarction,
cardiomyopathy, myocarditis, pulmonary
embolus or chest trauma

14. chaotic atrial depolarization
The atria contract irregularly and very rapidly
producing variable R-R intervals
No regular P waves are identifiable and the
baseline is undulating.
rheumatic heart disease, hypertension, ischemic
heart disease, pericarditis, thyrotoxicosis,
alcohol intoxication, mitral valve prolapse, and
digitalis toxicity

16. Irregular rhythm.
P waves change shape as pacemaker location varies.
Rate under 100/minute
QRS- NORMAL
PSVT

17. Same as P.A.T. but only every second (or more)
P’ wave produces a QRS.

19. P waveusually have a different morphology than
sinus P waves because they originate from an
ectopic pacemaker
QRSnormal
Conductionnormal, however the ectopic beats
may have a different P-R interval.
RhythmPAC's occur early in the cycle and they
usually do not have a complete compensatory
pause.

21. 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.