Internal Medicine

P1: SBT

0521779407-05 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:49

194 Atrial Premature Complexes

Atrial Premature Complexes............................

EDMUND C. KEUNG, MD

history & physical

History

■Most common cause of an irregular pulse. Often induced by stress,

tobacco, excessive caffeine or alcohol intake. Common in structural

heart diseases.

Signs & Symptoms

■Often asymptomatic. Palpitation and irregular pulse. Rarely, fatigue

and exacerbation of heart failure.

tests

■Basic Tests

➣12-lead ECG:

➣Premature P wave with or without conduction to ventricle

(blocked APC). Premature P wave morphology and P-R inter-

val differ from sinus P wave and conduction. Premature P wave

often masked by preceding T wave. Post-premature pauses usu-

ally non-compensatory

■Specific Diagnostic Test

➣none

differential diagnosis

■Ventricular premature complex, junctional premature complex.

management

What to Do First

■12-lead ECG

General Measures

■Abstin from alcohol and caffeine

specific therapy

■Generally requires no treatment. In symptomatic patients, reassur-

ance, digoxin, beta and calcium channel blocker.

Side Effects & Contraindications

■Excessive suppression of AVN or sinus node activity with beta block-

ers or calcium channel blockers.