Difference between revisions of "Atrial tachycardia"

(Management)
 
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==Background==
 
==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==
 
==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]]
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**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==
 
==Differential Diagnosis==
 
{{Tachycardia (narrow) DDX}}
 
{{Tachycardia (narrow) DDX}}
  
==Evaluation==
+
. 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.
  
 +
. 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.
  
 
==Management==
 
==Management==
  
  
==Disposition==
 
  
 +
◼︎  Non-sustained episodes of focal tachycardia are commonly seen on ambulatory ECG monitoring and are often a symptomatic.
 +
 +
◼︎  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.
  
==See Also==
+
◼︎  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.
  
 
==External Links==
 
==External Links==

Latest revision as of 21:01, 28 March 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

Narrow-complex tachycardia

. 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.

. 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.

Management

◼︎  Non-sustained episodes of focal tachycardia are commonly seen on ambulatory ECG monitoring and are often a symptomatic. 
◼︎  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. 
◼︎  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.

External Links

References