A 74-year-old man with severe COPD hospitalized for acute dyspnea receives albuterol and ipratropium nebulizers. He develops palpitations and dyspnea. Vital signs: BP 142/88, HR 128 and irregular, RR 22, SpO2 89% on 2L oxygen, temperature 37.2°C. Physical examination reveals an irregularly irregular pulse with no murmurs. ECG demonstrates narrow QRS complexes with at least three distinct P-wave morphologies. Serum potassium is 3.2 mEq/L. Which diagnosis best explains these findings?
- A)Atrial flutter
- B)Ventricular tachycardia
- C)Atrial fibrillation
- D)AV nodal reentrant tachycardia
- E)Multifocal atrial tachycardiaGABARITO
Explicação
This is multifocal atrial tachycardia, which is classically associated with pulmonary disease. The irregular rhythm and at least 3 different P-wave morphologies indicate multiple ectopic atrial pacemakers rather than a single reentrant circuit. Ver explicação completa e trilha adaptativa →