Irregular cardiac rhythm in a woman with asthma.

Proc (Bayl Univ Med Cent) 2012;25(2):159–160 A n obese (height, 62 inches; weight, 252 lb; body mass index, 46.2 kg/m2) 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). Th us, 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). From the Department of Medicine, Louisiana State University Health Sciences Center, and the Interim Louisiana State University Public Hospital, New Orleans, Louisiana.