MAT vs AFIB. Henry Clemo. Fast & Easy ECGs, 2E 2013 The McGraw-Hill Companies, Inc. All rights reserved.

Transcription

1 MAT vs AFIB Henry Clemo 1

2 Multifocal Atrial Tachycardia (MAT) > 3 P wave morphologies HR > 100 HR < 100 wandering pacemaker I 2

3 Multifocal Atrial Tachycardia 3

4 Multifocal Atrial Tachycardia 4

5 Multifocal Atrial Tachycardia MAT AFIB 5

6 Appearance of Multifocal Atrial Tachycardia (MAT) MAT is often misdiagnosed as atrial fibrillation with rapid ventricular response but can be identified by looking closely for clearly visible but changing P waves P waves change in morphology as often as from beat to beat resulting in three or more differentlooking P waves Varying PR intervals and narrow QRS complexes also seen 6

7 Causes of Multifocal Atrial Tachycardia Is more common in the elderly It is usually precipitated by acute exacerbation (with resultant hypoxia) of COPD, elevated atrial pressures, or heart failure Other causes include: recent surgery, sepsis, acute renal failure (MAT) 7

8 Effects of Multifocal Atrial Tachycardia (MAT) Patient may complain of palpitations Signs and symptoms of decreased cardiac output, such as hypotension, syncope, and blurred vision, may be seen 8

9 Treatment of Multifocal Atrial Tachycardia (MAT) Appropriate therapy is treatment of the underlying condition Correct electrolytes Limit catecholaminergic drugs In symptomatic patients treatment may include administering calcium channel blockers (verapamil, diltiazem) Caution with beta blockers in acute CHF and COPD flair 9

10 Multifocal Atrial Tachycardia > 50% of MAT may degenerate to AFIB Catecholaminergic meds such as theophylline, nebulizers, inotropes can precipitate Also association with hypomagnesemia and hypokalemia Because of underlying disease states, patients with MAT have a high mortality rate 10

11 Atrial Fibrillation Results for chaotic, asynchronous firing of multiple areas within the atria I 11

12 Appearance of Atrial Fibrillation Totally irregular rhythm with no discernible P waves Instead there is a chaotic baseline of fibrillatory waves (f waves) representing atrial activity 12

13 Causes of Atrial Fibrillation Atrial fibrillation is more common than atrial tachycardia or atrial flutter It can occur in healthy persons after excessive caffeine, alcohol, or tobacco ingestion or because of fatigue and acute stress Other causes include: 13

14 Effects of Atrial Fibrillation Leads to loss of atrial kick decreasing cardiac output by up to 25% Patients may develop intra-atrial emboli as the atria are not contracting and blood stagnates in the atrial chambers forming a thrombus (clot) Predisposes patient to systemic emboli (stroke) 14

15 Treatment of Atrial Fibrillation If the rate of ventricular response is normal, the dysrhythmia is usually well tolerated and requires no immediate intervention Patients experiencing atrial fibrillation and an associated rapid ventricular rate who are symptomatic but stable, treatment is directed at controlling the rate or converting the rhythm to sinus rhythm 15

16 Treatment of Atrial Fibrillation Symptomatic patients (e.g., hypotension, signs of shock, or heart failure) should receive oxygen, an IV infusion of normal saline administered at a TKO rate, and prompt synchronized cardioversion If necessary, the energy level may be increased with subsequent shocks 16

17 Practice Makes Perfect Determine the type of dysrhythmia I 17

18 Practice Makes Perfect Determine the type of dysrhythmia I 18

19 Practice Makes Perfect Determine the type of dysrhythmia I 19

20 Practice Makes Perfect Determine the type of dysrhythmia I 20

21 Practice Makes Perfect Determine the type of dysrhythmia I 21

22 Practice Makes Perfect Determine the type of dysrhythmia I 22

23 Practice Makes Perfect Determine the type of dysrhythmia I 23

24 Practice Makes Perfect Determine the type of dysrhythmia I 24

25 Practice Makes Perfect Determine the type of dysrhythmia I 25

26 Practice Makes Perfect Determine the type of dysrhythmia I 26