Case Presentation
Patient History
- Age: 72 years
- Sex: Female
- Chief Complaint: Palpitations and shortness of breath
- Duration: Symptoms started 3 days prior to presentation
- Associated Symptoms:
- Fatigue
- Dizziness
- Occasional chest discomfort
- Medical History:
- Chronic obstructive pulmonary disease (COPD) for 10 years
- Hypertension for 15 years
- Heart failure with preserved ejection fraction (HFpEF)
- Family History:
- No significant cardiac history
- Social History:
- Former smoker (40 pack-years, quit 5 years ago)
- No alcohol or illicit drug use
- Medications:
- Albuterol inhaler
- Lisinopril
- Furosemide
- Aspirin
Examination Findings
- General Appearance:
- Patient appears anxious and mildly dyspneic
- Vital Signs:
- Blood Pressure: 135/85 mmHg
- Heart Rate: 130 beats per minute
- Respiratory Rate: 24 breaths per minute
- Temperature: 97.8°F
- Oxygen Saturation: 88% on room air
- Cardiovascular Examination:
- Irregularly irregular rhythm
- No murmurs, rubs, or gallops
- No jugular venous distension
- Respiratory Examination:
- Bilateral wheezing
- Prolonged expiratory phase
- Other:
- No peripheral edema
ECG Findings
- ECG Characteristics:
- Irregularly irregular rhythm
- Heart rate: 120-150 beats per minute
- At least three different P-wave morphologies
- Variable PR intervals
- Inconsistent R-R intervals
- Interpretation:
- Findings consistent with multifocal atrial tachycardia
Laboratory Tests
- Complete Blood Count (CBC):
- Hemoglobin: 14 g/dL
- White Blood Cell Count: 8,000 cells/mm³
- Platelets: 250,000 cells/mm³
- Basic Metabolic Panel (BMP):
- Sodium: 140 mmol/L
- Potassium: 3.8 mmol/L
- Chloride: 100 mmol/L
- Bicarbonate: 24 mmol/L
- Blood Urea Nitrogen (BUN): 18 mg/dL
- Creatinine: 1.0 mg/dL
- Glucose: 110 mg/dL
- Arterial Blood Gas (ABG):
- pH: 7.45
- pCO₂: 40 mmHg
- pO₂: 60 mmHg
- HCO₃⁻: 26 mEq/L
- Other Tests:
- Troponin: Normal
- B-type Natriuretic Peptide (BNP): Elevated
Diagnosis
The diagnosis of multifocal atrial tachycardia (MAT) was made based on:
- Clinical Presentation: Palpitations and shortness of breath in a patient with underlying COPD.
- ECG Findings: Multiple P-wave morphologies, irregular rhythm, and inconsistent R-R intervals.
- Supporting Laboratory Data: Normal troponin levels, elevated BNP indicating cardiac stress, and ABG showing mild hypoxemia.
Conclusion
Multifocal Atrial Tachycardia is a significant arrhythmia often seen in patients with pulmonary diseases such as COPD. Timely diagnosis through clinical evaluation and ECG interpretation is crucial for effective management. Treatment focuses on addressing the underlying cause, improving oxygenation, and controlling the heart rate to alleviate symptoms and prevent complications.
