Podcast
Questions and Answers
Which of the following conditions is LEAST likely to be associated with premature atrial contractions (PACs)?
Which of the following conditions is LEAST likely to be associated with premature atrial contractions (PACs)?
- Digitalis toxicity
- Caffeine consumption
- Occasional PACs with no underlying heart disease (correct)
- Hypoxia
What is a typical characteristic of the PR interval in Paroxysmal Atrial Tachycardia (PAT)?
What is a typical characteristic of the PR interval in Paroxysmal Atrial Tachycardia (PAT)?
- Prolonged beyond 0.20 seconds
- Absent
- Variable, with no discernible pattern
- Constant, within the range of 0.12-0.20 seconds (correct)
Which characteristic is NOT typically associated with rhythms originating in the atria?
Which characteristic is NOT typically associated with rhythms originating in the atria?
- Presence of P waves of three or more different shapes
- Matching upright P waves with an atrial rate > 160 at rest
- Premature, abnormal P wave interrupting another rhythm
- HR < 60, rhythm regular, P waves discernible (correct)
Which of the following factors can be hidden in T waves?
Which of the following factors can be hidden in T waves?
In the context of premature atrial complexes (PACs), what is the typical morphology of the P wave?
In the context of premature atrial complexes (PACs), what is the typical morphology of the P wave?
What distinguishes the rhythm in paroxysmal atrial tachycardia (PAT) from sinus tachycardia?
What distinguishes the rhythm in paroxysmal atrial tachycardia (PAT) from sinus tachycardia?
What distinguishes Multifocal Atrial Tachycardia (MAT) from other atrial arrhythmias?
What distinguishes Multifocal Atrial Tachycardia (MAT) from other atrial arrhythmias?
Which of the following medications or substances is LEAST likely to contribute to atrial tachycardia?
Which of the following medications or substances is LEAST likely to contribute to atrial tachycardia?
What is a common cause of Wandering Atrial Pacemaker (WAP)?
What is a common cause of Wandering Atrial Pacemaker (WAP)?
Which pharmacologic intervention is LEAST likely to be used in the treatment of Multifocal Atrial Tachycardia (MAT)?
Which pharmacologic intervention is LEAST likely to be used in the treatment of Multifocal Atrial Tachycardia (MAT)?
In atrial fibrillation, what rhythm characteristic would you expect to observe?
In atrial fibrillation, what rhythm characteristic would you expect to observe?
What is the typical PR interval duration associated with Premature Atrial Complexes (PACs)?
What is the typical PR interval duration associated with Premature Atrial Complexes (PACs)?
What is the typical heart rate range observed in Paroxysmal Atrial Tachycardia (PAT)?
What is the typical heart rate range observed in Paroxysmal Atrial Tachycardia (PAT)?
In the context of arrhythmia analysis, what does 'CO decreased' indicate as a potential cause?
In the context of arrhythmia analysis, what does 'CO decreased' indicate as a potential cause?
In distinguishing between WAP and MAT, which of the following is MOST characteristic of MAT?
In distinguishing between WAP and MAT, which of the following is MOST characteristic of MAT?
A patient presents with a narrow QRS complex tachycardia. Distinguishing between sinus tachycardia and paroxysmal atrial tachycardia (PAT) can be challenging. Which additional finding would STRONGLY favor a diagnosis of PAT over sinus tachycardia?
A patient presents with a narrow QRS complex tachycardia. Distinguishing between sinus tachycardia and paroxysmal atrial tachycardia (PAT) can be challenging. Which additional finding would STRONGLY favor a diagnosis of PAT over sinus tachycardia?
A patient's EKG shows an irregular rhythm with a rate of 90 bpm. P waves are present, but each appears with a different morphology. The PR interval varies. Which arrhythmia is most likely?
A patient's EKG shows an irregular rhythm with a rate of 90 bpm. P waves are present, but each appears with a different morphology. The PR interval varies. Which arrhythmia is most likely?
An ECG tracing shows a rhythm with a rate of 180 bpm, regular R-R intervals, narrow QRS complexes, and P waves that are buried within the preceding T waves. What is the MOST likely diagnosis?
An ECG tracing shows a rhythm with a rate of 180 bpm, regular R-R intervals, narrow QRS complexes, and P waves that are buried within the preceding T waves. What is the MOST likely diagnosis?
Which of the following is the MOST critical difference in the underlying mechanism between Premature Atrial Complexes (PACs) and Multifocal Atrial Tachycardia (MAT)?
Which of the following is the MOST critical difference in the underlying mechanism between Premature Atrial Complexes (PACs) and Multifocal Atrial Tachycardia (MAT)?
A patient with a history of chronic obstructive pulmonary disease (COPD) presents with an irregular tachycardia. The EKG shows P waves with varying morphologies at a rate of 110 bpm. What is the MOST appropriate initial management strategy?
A patient with a history of chronic obstructive pulmonary disease (COPD) presents with an irregular tachycardia. The EKG shows P waves with varying morphologies at a rate of 110 bpm. What is the MOST appropriate initial management strategy?
Flashcards
Atrial Rhythm Criteria
Atrial Rhythm Criteria
Atrial rhythms criteria include matching upright P waves, atrial rate >160 at rest, no P waves (wavy baseline), P waves of ≥ 3 different shapes, premature abnormal P wave, or HR ≥ 130 with indiscernible P waves.
WAP vs. MAT
WAP vs. MAT
Wandering Atrial Pacemaker (WAP) has a rate <100, irregular rhythm, at least 3 different P wave shapes, and variable PR intervals. Multifocal Atrial Tachycardia (MAT) shares similar P wave characteristics.
Causes of WAP/MAT
Causes of WAP/MAT
WAP is often caused by hypoxia, vagal stimulation, or MI. MAT is commonly associated with COPD or heart disease.
Treatment for WAP/MAT
Treatment for WAP/MAT
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Premature Atrial Complex (PAC)
Premature Atrial Complex (PAC)
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PAC Intervals
PAC Intervals
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Cause of PACs
Cause of PACs
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Significance of PACs
Significance of PACs
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Treatment of PACs
Treatment of PACs
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Identifying Atrial Rhythms
Identifying Atrial Rhythms
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Premature Atrial Contraction (PAC)
Premature Atrial Contraction (PAC)
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Paroxysmal Atrial Tachycardia (PAT)
Paroxysmal Atrial Tachycardia (PAT)
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Atrial Tachycardia
Atrial Tachycardia
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Rhythm in PAT
Rhythm in PAT
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PR interval in PAT
PR interval in PAT
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PR interval with PACs
PR interval with PACs
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Causes of prolonged PR Interval
Causes of prolonged PR Interval
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P wave shape
P wave shape
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Premature P waves
Premature P waves
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Study Notes
Criteria for Rhythms Originating in the Atria
- Matching upright P waves, atrial rate (heart rate of the P waves) >160 at rest
- Absence of P waves: wavy or sawtooth baseline between QRS present
- Presence of P waves of ≥ 3 different shapes
- Premature abnormal P wave (with or without QRS) interrupting another rhythm
- HR ≥ 130, regular rhythm, P waves not discernible (may or may not be present)
Wandering Atrial Pacemaker (WAP) / Multifocal Atrial Tachycardia (MAT)
- WAP rate: <100
- MAT rate: >100
- Irregular rhythm
- P waves have at least 3 different shapes or are not present at all
- PR interval varies
- QRS interval is <0.12s
- Causes of WAP include medication side effects, hypoxia, or vagal stimulation or MI
- Causes of MAT include COPD or heart disease.
- WAP usually does not have adverse effects and requires no treatment
- MAT can have signs of decreased cardiac output if heart rate is too fast
- Treatment for MAT includes beta blockers or calcium channel blockers if cardiac output is decreased
Premature Atrial Complexes (PAC)
- Can occur at any rate
- Regular rhythm but interrupted
- P waves shaped differently from sinus P waves
- Premature P waves may be hidden in T waves
- PR interval is 0.12-0.20s
- QRS is <0.12
- Hyper atria fires early, before the next beat causing PACs
- Medications, stimulants, caffeine, bronchodilators, tobacco, hypoxia, or heart disease can all cause PACs
- Frequent PACs can be an early sign of impending heart failure, atrial tachycardia, or atrial fibrillation
- No ill effects from
- Treatment includes omitting stimulants such as caffeine and tobacco is needed
Paroxysmal Atrial Tachycardia (PAT)
- Rate 160-250 on the atrial tachycardia, however the rhythm it interrupts will have a different rate
- Rhythm is regular but interrupted
- P waves are shaped the same as in atrial tachycardia, but different from sinus P wave
- PR interval is 0.12-0.20s, constant
- QRS is <0.12s
- Same causes as PACs or Sinus Tachycardia
- Prolonged causes decreased CO
- Digitalis, Calcium channel blockers, beta-blockers, sedation, amiodarone, adenosine, and O2 are potential treatments
- Elective cardioversion is also an option
Atrial Flutter
- Rate 250-350
- Rhythm is regular if conduction ratio is constant, irregular if conduction ratio varies
- No P waves present
- Sawtooth shaped waves between QRS complexes
- PR not measured
- QRS is <0.12s
- Almost always implies heart disease, pulmonary embolism, valvular heart disease, thyroid storm, or lung disease
- Decreased CO
- Digitalis, Calcium Channel blockers, beta blockers, adenosine, or carotid sinus massage all are potential treatments
- Cardioversion is also an option
Atrial Fibrillation
- Rate 350-700
- Irregular rhythm and completely unpredictable
- No P waves
- No PR interval
- QRS is <0.12
- MI, lung disease, valvular heart disease, or hyperthyroidism can all cause atrial fibrillation
- Drop in CO and blood clots can result
- MI, strokes or blood clots in the lung
- Treatment depends on duration
- In pts with Afib greater than 48 hrs, anticoagulants and cardioversion are treatment options
Supraventricular Tachycardia (SVT)
- Rate is 130 or higher
- Regular rhythm
- P waves are not discernible
- PR cannot be measured
- QRS is <0.12
- SAME as PAT
- Decreased CO secondary to rapid HR
- Adenosine, digitalis, ibutilide, Calcium channel blockers, or beta blockers are all potential treatments
- SVT is sometimes delayed
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Description
Understanding rhythms originating in the atria, including Wandering Atrial Pacemaker (WAP) and Multifocal Atrial Tachycardia (MAT). Covers rates, rhythm irregularities, P wave characteristics, PR intervals, and QRS complex duration. Discusses causes such as medication side effects, hypoxia, COPD, and heart disease.
