{"id":705,"date":"2017-04-03T00:01:01","date_gmt":"2017-04-03T00:01:01","guid":{"rendered":"http:\/\/torreyekg.com\/?p=705"},"modified":"2017-03-13T14:00:41","modified_gmt":"2017-03-13T14:00:41","slug":"ekg-of-the-week-49","status":"publish","type":"post","link":"http:\/\/torreyekg.com\/index.php\/2017\/04\/03\/ekg-of-the-week-49\/","title":{"rendered":"EKG of the Week #49"},"content":{"rendered":"<p><a href=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2017\/04\/49.png\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2017\/04\/49.png\" alt=\"\" width=\"691\" height=\"384\" class=\"alignnone size-full wp-image-718\" srcset=\"http:\/\/torreyekg.com\/wp-content\/uploads\/2017\/04\/49.png 691w, http:\/\/torreyekg.com\/wp-content\/uploads\/2017\/04\/49-300x167.png 300w\" sizes=\"auto, (max-width: 691px) 100vw, 691px\" \/><\/a><br \/>\n58-year-old woman with COPD presents with a cough and darker sputum for 1 week.  EKG read as atrial fib.  What do you think? <\/p>\n<div class=\"spoiler-wrap\"><div class=\"spoiler-head collapsed\" title=\"Expand\">Answer &amp; Explanation<\/div><div class=\"spoiler-body\" style=\"display: none;\"><br \/>\nEKG interpretation:<br \/>\n\tIrregularly irregular narrow complex at 115\/minute \u2013 ? rhythm<br \/>\n\tAxis \u2013 normal<br \/>\n\tIntervals \u2013 there is a P wave in many R-R spaces, of varying PR<br \/>\n\tNo chamber enlargement, ischemia or infarct patterns\n<p>There are two irregularly irregular rhythms \u2013 atrial fibrillation and multifocal atrial tachycardia (MAT).  MAT is defined as >3 ectopic atrial foci with P waves of differing P wave morphology and differing PR intervals.  The R-R intervals are necessarily irregularly irregular.  In many of the R-R intervals in this lead II rhythm strip, notice that the T wave is \u201cdeformed\u201d by the addition of a P wave.<\/p>\n<p>MAT is often seen in COPD, especially during exacerbation.  Other causes are any critical illness, especially with depletion of electrolytes and cations.  There is no specific treatment of MAT \u2013 first, remedy any underlying process like hypoxia, exacerbation of COPD, fluid status.<\/p>\n<p>And remember this sneaky rhythm when atrial fibrillation with very rapid ventricular rate doesn\u2019t respond to usual treatment for a fib \u2013 it may be misdiagnosed multifocal atrial tachycardia (MAT)!<br \/>\n<\/p><\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>58-year-old woman with COPD presents with a cough and darker sputum for 1 week. EKG read as atrial fib. What do you think?<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-705","post","type-post","status-publish","format-standard","hentry","category-ekg-of-the-week"],"_links":{"self":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/705","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/comments?post=705"}],"version-history":[{"count":2,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/705\/revisions"}],"predecessor-version":[{"id":719,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/posts\/705\/revisions\/719"}],"wp:attachment":[{"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/media?parent=705"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/categories?post=705"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/torreyekg.com\/index.php\/wp-json\/wp\/v2\/tags?post=705"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}