1/26/2024 0 Comments Atrial flutter management![]() Amal Mattu recommends flipping ECG 180 to easily see inverted P waves or speed machine up to 50 mm/s to stretch out ECG.A-fib is completely irregular with no relationship between intervals.Look for: R-R interval that is multiple of P-P interval and mathematical relationship between R-R intervals.Difficult to distinguish from atrial fibrillation.Suggests AV nodal blocking agents or AV node disease.Suspect atrial flutter whenever ventricular rate is 150.Suggests pre-excitation, sympathetic excess, parasympathetic withdrawal, Class 1C anti-arrhythmic use.Hallmark is discordance in flutter wave direction between inferior leads and V1.Flutter waves (sawtooth pattern) in inferior leads. ![]() Usually regular unless variable AV conduction present.Cardiac Echo - if signs of new/worsening heart failure.Second Degree AV Block Type I (Wenckeback).Atrial fibrillation/ atrial flutter with variable AV conduction AND accessory pathway (e.g.Atrial fibrillation/ atrial flutter with variable AV conduction AND bundle branch block^.Accelerated idioventricular rhythm (consider if less than or ~120 bpm).Sinus tachycardia with bundle branch block^.Atrial flutter with bundle branch block^.Atrial flutter with variable conductionĪssume any wide-complex tachycardia is ventricular tachycardia until proven otherwise (it is safer to incorrectly assume a ventricular dysrhythmia than supraventricular tachycardia with abberancy).Sinus tachycardia with frequent PACs, PJCs, PVCs.Paroxysmal supraventricular tachycardia (PSVT).Idiopathic fascicular left ventricular tachycardia.Atrial tachycardia (uni-focal or multi-focal).Defined by atrial rate of 250-350, classically 300Ĭan be difficult to distinguish from atrial fibrillation Narrow-complex tachycardia.5.4.1 Anticoagulation Prior to Cardioversion.DON’T use any medicines (including over-the-counter and herbal products) without first asking your health care provider.DON’T stop taking your medicine or change the dosage because you feel better unless your health care provider- doctor tells you to.DON’T take part in activities that cause bruising if you’re taking anticoagulants.These include chest pain shortness of breath breathing problems fainting palpitations or sudden changes in the ability to speak, eat, walk, or use your limbs. DO call your health care provider if you have side effects from medicines or have new or worsening symptoms.DOs and DON’Ts in Managing Atrial Flutter: EPS may help the health care provider decide about other treatment options such as radiofrequency ablation, pacemaker insertion, and surgery. A cardiologist specializing in heart rhythm problems does this test. If all these measures don’t work, the health care provider may suggest an electrophysiologic study (EPS). The brief electric shock stops the heart’s electrical activity and may allow normal heart rhythm to take over. This procedure is called electrical cardioversion. If that doesn’t work or symptoms get worse, the heart is electrically shocked. Medicines help control the rate of contraction of ventricles and try to get back the heart’s normal rhythm (chemical cardioversion). Treatment depends on the symptoms and cause. Keeping a normal regular heart rhythm is another goal. Treatment aims to fix the cause of the rhythm disturbance, slow the heart rate, and prevent blood clots. The health care provider may want laboratory tests to rule out other disorders such as overactive thyroid gland. This test can see the motion of the atria and whether blood clots are in the atria. ECG looks at the heart’s electrical conduction system and can confirm the diagnosis. The health care provider makes a diagnosis from the medical history, physical examination, and electrocardiography (ECG). Breathing problems, chest pain, and fainting occur with heart failure. Angina is heart pain caused by a low blood supply to the heart. Main symptoms are palpitations (feeling that the heart is pounding or racing), dizziness, lightheadedness, and feeling faint. Heart and lung disease, thyroid disease, and heart valve disorders are most often associated with atrial flutter. What Causes Atrial Flutter?ĭifferent illnesses can cause atrial flutter. ![]() Atrial flutter more often occurs in older adults, mostly men. About one-half to one-fourth of these impulses get to the ventricles. Atria may beat up to 300 times per minute, instead of 60 to 100. The atria flutter as they try to contract, but the contractions are too fast. In atrial flutter, the atria start to beat rapidly because of too many abnormal electrical impulses. The atria are the top chambers of the heart.
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