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Tachyarrhythmia: Multifocal Atrial Tachycardia and Wolff-Parkinson-White-Syndrome (WPW)

by Carlo Raj, MD
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    Let us continue. We will take a look at supraventricular tachycardias. The way that this is set up is so that we haven't given you all four. I haven't given you all four. Tachyarrhythmia is here so that you are not confused as to which one is which. There was a discussion with atrial flutter and atrial fibrillation and we distinguished between the two very clearly, primarily in terms of its description, irregularly irregular would be which one? Atrial fibrillation. If it is regular and you have a 2:1 type of pattern, which means two P waves for every one QRS complex, then you have a regular rhythm and this will then bring us to flutter and saw-tooth. So these were the two supraventricular tachycardias that you need to make sure that you know in great detail and then here we will take a look at two others. One known as multifocal atrial tachycardia. Now we will do the same thing. Do not allow the name to fool you, confuse you and frustrate you, in fact, used the name to then clue you when as to the diagnosis of your patient. So multifocal atrial tachycardia is once again dealing with the atria, thus, it is a SVT, a supraventricular tachycardia. Keep in mind that the objective at all times is to make sure that you prevent these tachycardias from entering the ventricles. Due to focal pacemaker abnormalities, I will tell you what that means in a second and what end up happening here is a multifocal or multiple ectopic pacemaker firing. And by a pacemaker, we are referring to our SA node. Thus, the P wave is going to be quite operative for us to pay attention to, leading to tachycardia of course. Rapid abnormal P wave, well that once...

    About the Lecture

    The lecture Tachyarrhythmia: Multifocal Atrial Tachycardia and Wolff-Parkinson-White-Syndrome (WPW) by Carlo Raj, MD is from the course Arrythmias. It contains the following chapters:

    • Multi-Focal Atrial Tachycardia: Pathogenesis
    • Multi-focal Atrial Tachycardia: Diagnosis & Treatment
    • Wolf-Parkinson White Syndrome: Definition
    • Wolf-Parkinson White Syndrome: Diagnosis & Treatment
    • For The Boards

    Included Quiz Questions

    1. All may be treated with digoxin.
    2. Heart rate must be above 100 bpm.
    3. They share common etiologies such as hypertension and ischemic heart disease.
    4. Main goal of therapy is avoiding transmission of arrhythmia to the ventricles.
    5. Always involves abnormalities of the p wave.
    1. WAP has a heart rate < 100 bpm, while MAT must be > 100 bpm.
    2. Digoxin is effective in only MAT.
    3. They affect different phases of the action potential.
    4. Only MAT must be treated.
    5. WAP may be differentiated by the morphology of the p wave.
    1. Abnormal QRS complex morphology.
    2. Heart rate > 100 bpm.
    3. Irregular atrial rate.
    4. Must be expressed on a single ECG rhythm strip.
    5. 3 distinct P wave morphologies must be seen.
    1. Digoxin
    2. Metoprolol
    3. Aspirin
    4. Warfarin
    5. Verapamil
    1. Heart rate is slowed by increasing the gradient of phase 4.
    2. It is associated with the “funny” channel.
    3. It can be modulated by using beta blockers.
    4. It involves the movement of Na.
    5. It can be modulated by acetylcholine.
    1. Look for an upright QRS complex following a p wave on lead II.
    2. Look at the rhythm strip for regular R-R intervals.
    3. Look for an inverted p wave and an inverted QRS complex on lead II.
    4. Look for an inverted p wave following a QRS complex on lead II.
    5. Look at lead I for a p wave with normal morphology followed by any QRS complex.
    1. It is the only pre-excitation syndrome.
    2. It is a congenital issue.
    3. It causes symptoms associated with decreased cardiac output.
    4. It has a PR interval < 120 ms.
    5. It involves the Bundle of Kent.
    1. AV block
    2. Atrial fibrillation
    3. Ebstein’s anomaly
    4. Hypertrophic cardiomyopathy
    5. Atrial flutter
    1. Abnormal p wave morphology
    2. PR interval <0.12s
    3. QRS widening
    4. Delta wave
    5. Upward sloping QRS complex
    1. Loss of normal delay between SA node and AV node due to presence of a bypass tract.
    2. Disordered atrial contraction from multiple ectopic foci.
    3. Increased delay between SA node and AV node due to fibrotic changes.
    4. Disordered atrial contraction due to ischemic heart tissue.
    5. None of the answers are correct.
    1. Procainamide
    2. Flecainide
    3. Metoprolol
    4. Verapamil
    5. Digoxin
    1. Metoprolol
    2. Adenosine
    3. Verapamil
    4. Digoxin
    5. All are contraindicated
    1. It blocks only the activated voltage gated sodium channel.
    2. It blocks both the activated and inactivated voltage gated sodium channel.
    3. It decreases the gradient of phase 4 of the action potential.
    4. It blocks the calcium channel.
    5. It blocks the ligand gated sodium channel.
    1. Surgical ablation of the accessory pathway.
    2. Medical cardioversion.
    3. Pacemaker placement.
    4. There is no definitive treatment option for WPW.
    5. Electrical cardioversion.
    1. 100 bpm
    2. 150 bpm
    3. 75 bpm
    4. 60 bpm
    5. 300 bpm
    1. HR 120, BP 80/40 in an unconscious patient with cold, clammy skin.
    2. HR 90, BP 80/40 in an unconscious patient with warm skin.
    3. HR 90, BP 100/80 in a patient with cold clammy skin and diaphoresis.
    4. HR 120, BP 80/40 in a patient with mild respiratory distress.
    5. HR 120, BP 120/80 in a patient with diaphoresis and able to speak comfortably.
    1. Carotid massage
    2. Adenosine
    3. Digoxin
    4. Beta blockers
    5. Electrical cardioversion
    1. WPW
    2. Atrial tachycardia
    3. Atrial flutter
    4. Atrial fibrillation
    5. Wandering atrial pacemaker

    Author of lecture Tachyarrhythmia: Multifocal Atrial Tachycardia and Wolff-Parkinson-White-Syndrome (WPW)

     Carlo Raj, MD

    Carlo Raj, MD


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    Great lecture!!
    By M D R. on 20. February 2017 for Tachyarrhythmia: Multifocal Atrial Tachycardia and Wolff-Parkinson-White-Syndrome (WPW)

    I have traditionally had difficulty with the cardiovascular system, but listening to Dr. Raj and his cardiovascular lectures has changed that completely!! Absolutely love it!

     
    Good lecture but what about AVNRT and AVRT
    By Hamed S. on 18. February 2017 for Tachyarrhythmia: Multifocal Atrial Tachycardia and Wolff-Parkinson-White-Syndrome (WPW)

    Really good talk but would have been great to discuss the choice between rate and rhythm controlled Rx as well as a section devoided to AVNRT and AVRT. I'm still a bit confused about why the management differs between these two supraventricluar tachy and WPW