Irregular cardiac rhythm in a woman with asthma.
Subject: Paroxysmal tachycardia (Diagnosis)
Paroxysmal tachycardia (Reports)
Asthma (Complications and side effects)
Asthma (Reports)
Authors: Glancy, D. Luke
Hanna, Elias B.
Ilie, Camelia C.
Pub Date: 04/01/2012
Publication: Name: Baylor University Medical Center Proceedings Publisher: The Baylor University Medical Center Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 The Baylor University Medical Center ISSN: 0899-8280
Issue: Date: April, 2012 Source Volume: 25 Source Issue: 2
Accession Number: 306359156

An obese(height, 62 inches; weight, 252 lb; body mass index, 46.2 kg/[m.sup.2]) 54-year-old woman with longstanding asthma and chronic cigarette smoking came to the hospital with an acute asthma attack manifested by dyspnea, wheezing, and chest tightness. Her electrocardiogram showed an irregular atrial tachycardia(114 P waves/minute) with multiple P-wave morphologies, frequent aberrant ventricular conduction, and one nonconducted P wave(Figure). Thus, the patient had multifocal atrial tachycardia, also called chaotic atrial mechanism (1), chaotic atrial tachycardia(2), or chaotic atrial rhythm (3). As the name implies, multifocal atrial tachycardia has generally been thought to originate from multiple atrial foci, but because variable conduction of impulses from a single focus cannot be excluded, the mechanistically noncommittal term multiform atrial tachycardia has been suggested (4).

Multifocal atrial tachycardia usually is seen in patients who are severely ill with a noncardiac problem, which often, as in this patient, is an acute exacerbation of chronic lung disease. Beta-adrenergic agonists and theophylline may be contributing factors. Multifocal atrial tachycardia is often mistaken for atrial fibrillation. Although it is a distinct nosological entity, multifocal atrial tachycardia is often preceded or followed by other atrial arrhythmias, such as atrial fibrillation, atrial flutter, and other atrial tachycardias (2, 4). Multifocal atrial tachycardia usually disappears when the underlying medical problem has been controlled.

(1.) Phillips J, Spano J, Burch G. Chaotic atrial mechanism. Am Heart J 1969;78(2):171-179.

(2.) Lipson MJ, Naimi S. Multifocal atrial tachycardia (chaotic atrial tachycardia). Circulation 1970;42(3):397-407.

(3.) Berlinerblau R, Feder W. Chaotic atrial rhythm. J Electrocardiol 1972;5(2):135-144.

(4.) Surawicz B, Knilans TK. Chou's Electrocardiography in Clinical Practice, Adult and Pediatric(5th ed). Philadelphia: WEB. Saunders, 2001:340-341.

D. Luke Glancy, MD, Elias B. Hanna, MD, and Camelia C. Ilie, MD From the Department of Medicine, Louisiana State University Health Sciences Center, and the Interim Louisiana State University Public Hospital, New Orleans, Louisiana.

Corresponding author: D. Luke Glancy, MD, 7300 Lakeshore Drive, #30, New Orleans, Louisiana 70124(e-mail:
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