Prof.G.Sundaramurthy’s unit m7Dr.K.Bhargavi

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

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

Cardiac arrythmia Wandering atrial pacemaker The electrical impulse is generated at a

different focus within the atria of the heart each time.

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

Palpitations Shortness of breath Chest pain Lightheadedness Syncopal episodes

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.

Antiarrhythmics verapamil Magnesium sulfate potassium

Other atrial arrhythmias

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

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

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

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

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.

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.