Chapter 6

Question 1

Premature Atrial Complexes (PAC)

Answer 1

Characteristics:

Atria generate premature impulse

Clinical significance:

Occasional PAC’s are benign, cause palpitations

Management:

Recurrent PAC’s treated with digitalis

Question 2

Atrial Tachycardia

Answer 2

• Common forms are paroxysmal atrial tachycardia (PAT) and multifocal atrial tachycardia (MAT) aka wandering pacemaker.
• Diminishes atrial kick

Question 3

PAT

Answer 3

Characteristics:

Sudden onset of three or more beats of narrow complex tachycardia

Heart rate 150-250 bpm

Clinical significance:

isolated PAC’s are normal

Management:

Avoid caffine or cigarette smoking

Treatment if symptomatic: digoxin

Question 4

MAT aka wandering pacemaker

Answer 4

Characteristics:

More than one shaped P wave

Usually more than 3 types of identifiable types of P waves

Heart rate 100-150 bpm

Clinical significance:

mostly seen in patients with COPD.

Management:

improving underlying cause

Verapamil, Flecainide, Propafenone

Question 5

Atrial flutter

Answer 5

Characteristics:

Atrial rate of 250-400 bpm

most characteristic pattern is “saw tooth” shaped P waves called flutter waves

Clinical significance:

Commonly seen in patients with heart disease

Risk of thromboembolic events are high

Management:

Diltiazem, Verapamil, Digoxin

Question 6

Atrial fibrillation

Answer 6

Characteristics:

rapid, disorganized and irregular atrial activation

atrial rate above 400 bpm

Clinical significance:

fast ventricular response

loss of atrial appendage contractility leading to risk of clot formation

some patients present with severe dizziness or syncope

Treatment:

Direct current (DC) cardioversion; rate control, prevention of thromboembolic event, rhythm control