Which arrhythmia is commonly associated with severe chronic obstructive pulmonary disease?

• A. Atrial fibrillation
• B. Sinus tachycardia
• C. Multifocal atrial tachycardia
• D. Ventricular tachycardia

Answer: (C)

In severe COPD, a distinct atrial tachyarrhythmia called multifocal atrial tachycardia often appears. This rhythm comes from multiple atrial pacemaker sites due to atrial irritability from chronic hypoxemia, hypercapnia, and electrolyte disturbances typical of advanced COPD. On ECG it shows an irregular rhythm with at least three different P-wave morphologies and varying PR intervals, usually with a rate over 100 beats per minute. That combination—COPD with multiple, changing P waves and irregular rhythm—is what makes multifocal atrial tachycardia the pattern most characteristic of severe COPD, more so than sinus tachycardia (a general, nonspecific response to stress or hypoxia), atrial fibrillation (which lacks distinct P waves and has a different atrial activity pattern), or ventricular tachycardia (which is a rapid wide-complex rhythm not specifically tied to COPD). Management focuses on correcting hypoxemia and treating the COPD exacerbation, with rate control as needed using appropriate agents.