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multifocal (chaotic) atrial tachycardia (MAT)

Etiology: 1) hypoxia - COPD, heart failure, hypertension - often seen in end-stage COPD [5] 2) increased catecholamines 3) atrial stretch 4) local acid base & electrolyte disturbances 5) may be potentiated by theophylline Special laboratory: - electrocardiogram: a) rate 100-130 bpm b) variation in p - p intervals c) at least 3 distinct p-wave morphologies Management: 1) correction of underlying cause - oxygen 2) pharmacologic agents a) Ca+2 channel blocker (verapamil, diltiazem) b) beta blocker - avoid in patients with CHF or lung disease c) amiodarone c) digitalis is NOT useful & may worsen 3) NO DC cardioversion [4]

Related

verapamil (Isoptin, Calan, Verelan, Covera-HS, Iproveratril, Dilacorin, Cardioprotect)

General

atrial tachycardia

Figures/Diagrams

EKG: MAT, pacemaker

References

  1. Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 141-42
  2. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 273
  3. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 76
  4. ACLS - The Reference Texbook ACLS: Principles & Practice, Cummins RO et al (eds), American Heart Association, 2003 ISBN 0-87493-341-2
  5. Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022