Atrial fibrillation and atrial flutter

Question 1

Answer 1

Rate in 10 sec ECG strip: 11 R waves x 6 = 66 means/ min (ventricular rate (cannot count atrial rate in irregular rhythm)

Rhythm
R-R: irregular –> AFib
P-wave: no distinct P wave (lead II and aVR). Than look at V1 and lead II has fibrillatory waves.
P–> QRS (relationship): AV dissociation as no P wave
QRS: narrow

Atrial fibrillation = atrial rate (one small box) should be around 350-450bpm

Question 2

When you cant see P waves in lead II and aVR what leads do you look at next?

Answer 2

Lead V1 and lead II

Question 3

Answer 3

Rate = 150bpm

Rhythm
R-R: regular
P wave: no P wave in lead II and aVR –> look at V1 and lead II –> also no P wave (sawtooth appearance)
P–> QRS: There is AV association due to presence of 1:1 (atrial depolarization: ventricular depolarization) in lead II –> indicating no AV blocks
QRS: narrow QRS complex

Regular narrow complex tach has 3 options: sinus tach, Aflutter, SVT

Look for F waves (flutter) in V1, lead II, III and aVF

Typical Aflutter
Lead V1 = sawtooth pointing up
Lead II/III/aVF = sawtooth pointing down

Question 4

What leads to look at for atrial flutter?
How to count degree of conduction?

Answer 4