Difference between revisions of "Atrial tachycardia"

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==Differential Diagnosis==
 
==Differential Diagnosis==
{{Tachycardia (narrow) DDX}}
 
  
. Atrial Tachycardia differs from sinus tachycardia in that the impulses are generated by an ectopic focus somewhere within the atrial myocardium rather than the sinus node.  
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*Atrial tachycardia differs from sinus tachycardia in that the impulses are generated by an ectopic focus somewhere within the atrial myocardium rather than the sinus node.  
  
. The atrial (P wave), is usually100-250 /min with abnormally shaped P waves. The combination of focal atrial tachycardia with AV block is particularly common in digoxin toxicity.  
+
*The atrial (P wave), is usually 100-250 /min with abnormally shaped P waves. The combination of focal atrial tachycardia with AV block is particularly common in digoxin toxicity.  
  
. Multifocal atrial tachycardia can be mistaken for AF, due to its irregular nature, but closer inspection of the ECG will reveal P waves with at least three different morphologies.
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*Multifocal atrial tachycardia can be mistaken for AF, due to its irregular nature, but closer inspection of the ECG will reveal P waves with at least three different morphologies.
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 +
{{Tachycardia (narrow) DDX}}
  
 
==Management==
 
==Management==
  
 +
*Non-sustained episodes of focal tachycardia are commonly seen on ambulatory ECG monitoring and are often asymptomatic.
  
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*Sustained atrial tachycardia can lead to a tachycardia-induced cardiomyopathy and it is important not to misdiagnose the rhythm as [[sinus tachycardia]] in such cases.
  
◼︎  Non-sustained episodes of focal tachycardia are commonly seen on ambulatory ECG monitoring and are often a symptomatic.
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*Focal atrial tachycardia should be treated with urgent electrical [[cardioversion]] if the patient is unstable.  
 
 
◼︎  Sustained atrial Tachycardia can lead to a tachycardia -induced cardiomyopathy and it is important not to misdiagnose the rhythm as sinus tachycardia in such cases.
 
 
 
◼︎  Focal atrial tachycardia should be treated with urgent electrical cardio version if the patient is unstable.  
 
  
◼︎  Stable patients may cardiovert with adenosine or with beta blockers.  
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*Stable patients may cardiovert with [[adenosine]] or [[with beta blockers]].  
  
◼︎  If digoxin toxicity is the cause of the atrial tachycardia the drug should be stopped.
+
*If digoxin toxicity is the cause of the atrial tachycardia the drug should be stopped.
  
◼︎  Rate control and or prophylaxis against recurrent episodes can be attained usually with beta blockers, or calcium channel blockers.
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*Rate control and or prophylaxis against recurrent episodes can be attained usually with [[beta blockers]], or [[calcium channel blockers]].
  
 
==External Links==
 
==External Links==

Revision as of 18:05, 2 August 2020

Background

  • Also known as focal atrial tachycardia
  • Rate >100 bpm
  • Electrical focus that originates outside in the sinus node at a single location
    • By comparison, reentrant tachycardias (eg. AVRT, AVNRT) involve multiple foci/ larger circuits

Clinical Features

  • Palpitations
    • non-specific finding
    • associated with all tachydysrhythmias, not just AT
    • rapid fluttering/throbbing/pounding sensation in the chest or neck
  • Syncope
    • patients with AT rarely present with syncope
    • cerebral hypoperfusion is more common with a ventricular rate >200 bpm
  • Chest pain
    • can present if there is underlying cardiovascular disease
    • represents a worsening of the associated disease
  • Dyspnea
    • can present if there is underlying cardiovascular disease
    • represents a worsening of the associated disease

Differential Diagnosis

  • Atrial tachycardia differs from sinus tachycardia in that the impulses are generated by an ectopic focus somewhere within the atrial myocardium rather than the sinus node.
  • The atrial (P wave), is usually 100-250 /min with abnormally shaped P waves. The combination of focal atrial tachycardia with AV block is particularly common in digoxin toxicity.
  • Multifocal atrial tachycardia can be mistaken for AF, due to its irregular nature, but closer inspection of the ECG will reveal P waves with at least three different morphologies.

Narrow-complex tachycardia

Management

  • Non-sustained episodes of focal tachycardia are commonly seen on ambulatory ECG monitoring and are often asymptomatic.
  • Sustained atrial tachycardia can lead to a tachycardia-induced cardiomyopathy and it is important not to misdiagnose the rhythm as sinus tachycardia in such cases.
  • Focal atrial tachycardia should be treated with urgent electrical cardioversion if the patient is unstable.
  • If digoxin toxicity is the cause of the atrial tachycardia the drug should be stopped.

External Links

References