75-year old patient presenting with acute dyspnoea, productive cough and wheeze. Describe the ECG.

TOP 100 ECG QUIZ LITFL 033

Describe and interpret this ECG

ECG ANSWER and INTERPRETATION

Main Abnormalities

Diagnosis 

The combination of…

  • Irregular narrow-complex tachycardia (> 100 bpm)
  • Multifocal atrial activity (3 or more distinct P wave morphologies)
  • No evidence of flutter / AF

… is diagnostic of multifocal atrial tachycardia (MAT).

ECG changes of right ventricular hypertrophy may represent cor pulmonale due to COPD.


CLINICAL PEARLS

Clinical Significance

MAT typically occurs in patients with severe COPD, as the final common pathway of multiple arrhythmogenic mechanisms:

  • Right atrial dilatation (from cor pulmonale)
  • Increased sympathetic drive — due to hypoxia / hypercarbia
  • Bronchodilators — beta-agonist, theophylline
  • Electrolyte abnormalities; hypokalaemia and hypomagnesaemia (e.g. secondary to diuretics / beta-agonists)

MAT typically resolves with treatment of the underlying COPD exacerbation and correction of any electrolyte abnormalities, although it may evolve into AF or flutter.


TOP 100 ECG SERIES


Emergency Physician in Prehospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education | ECG Library |

MBBS (UWA) CCPU (RCE, Biliary, DVT, E-FAST, AAA) Emergency Medicine Advanced Trainee in Melbourne, Australia. Special interests in diagnostic and procedural ultrasound, medical education, and ECG interpretation. Editor-in-chief of the LITFL ECG Library. Twitter: @rob_buttner

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