atrial ectopics in MI patient age 59 years, 2 prior MI’s with stent placements 1st in 2000 next in 2004 norma?

pt developd emotional anxiety and few hrs later suffered from rhythmic heart irregularities was rushed to emergency ecg showed p-wave disturbance, irregularly irregular rhythm,heart raate 70- 80 (normal 65-68) diabetic pt since 25 years. doctors diagnosed ectopic atrial beats. whats the significance of it in prior mi patient. and wats the pathophysiology and management? pt happens 2 b my father

This may or may not be related to his previous myocardial infarctions. Normally a signal originates from the sinus atrial node in the upper chambers (atria) and then travels through the conductions system to the rest of the heart. An ectopic atrial beat originates somewhere else in the atria than the SA node. The p wave on EKG represents atrial depolarization leading to atrial contraction. Premature atrial contractions are ectopic beats, which are completely normal as long as they don’t occur frequently. It sounds like this person had something more than just a premature atrial contraction. Another possibility is a wandering atrial pacemaker in which there are 3 or more different atrial contractions originating from elsewhere than the SA node. This gives the appearance of 3 or more different types of p waves on the EKG. I am not sure if this is what your father had, but it is usually related to lung conditions like COPD and not heart attacks.

Another possibility is a rhythm called atrial fibrillation. An irregularly irregular heart rhythm is classic for atrial fibrillation. Atrial fibrillation is the most common heart arrhythmia and people may have it with no symptoms. It is basically related to quivering of the atria and is associated with the absence of p waves on the EKG. I am not sure if this is the rhythm the person had, because you said the EKG showed an p wave disturbance, which suggests that p waves were present but just abnormal. Atrial fibrillation and other atrial arrhythmias rarely are a presentation of a heart attack, but it is possible. Risk factors include age, heart failure, high blood pressure, diabetes, thyroid disease, etc.

So to answer your question, I think it is unlikely that this ectopic atrial rhythm is related to the person’s prior heart attacks, since the last one was in 2004. Heart attacks can lead to heart failure, which increases the risk of atrial and ventricular arrhythmias. The management depends on the exact rhythm present and the rate. A rate of 70-80 is within normal limits. Premature ectopic atrial beats usually do not require treatment unless they are associated with symptoms. Beta blockers could be used to reduce the incidence of premature beats if the symptoms are severe. Wandering atrial pacemaker is usually treated by treating the underlying condition, which is frequently COPD (emphysema + chronic bronchitis.) Atrial fibrillation treatment is more complex. The rate can be controlled with beta blockers or calcium channel blockers. Sometimes antiarrhythmic medications or cardioversion may be required. Atrial fibrillation increases the risk of blood clots forming in the heart, which can lead to strokes. Blood thinners are given in most cases to reduce the chance of stroke. You should discuss this with the person’s doctor though, because they know more details. Good luck.

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