Prehospital recognition of multifocal atrial tachycardia: association with acute myocardial infarction.

Patients with chronic obstructive pulmonary disease and acute decompensation commonly present with an irregularly irregular supraventricular tachycardia that is, in fact, multifocal atrial tachycardia, but frequently misdiagnosed as atrial fibrillation. To heighten awareness of this arrhythmia, its clinical and electrocardiographic presentations, and its potential therapeutic implications, two patients are reported who presented with multifocal atrial tachycardia during prehospital care. In these two patients the clinical substrate was not chronic obstructive pulmonary disease but instead acute myocardial infarction. By means of a high index of clinical suspicion and close scrutiny of an electrocardiogram, a diagnosis of multifocal atrial tachycardia can be established during prehospital management, and potentially ineffective therapeutic interventions can be avoided, both during prehospital care and in the emergency department.