Atrial Flutter Flashcards
What is atrial flutter a form of?
Supraventricular tachycardia
What is atrial flutter characterised by?
A succession of rapid atrial depolarisation waves
What is atrial flutter caused by?
a “re-entrant rhythm” in either atrium- the electrical signal re-circulates in a self-perpetuating loop
What is a re-re-entrant rhythm?
The electrical signal re-circulates in a self-perpetuating loop
What is the re-entrant rhythm due to?
An extra electrical pathway.
At what speed does the re-entrant rhythm stimulate atrial contractures?
300 bpm
How often does the signal make its way into the ventricles?
Every second lap due to the long refractory period to the AV node
At what speed does the re-entrant rhythm stimulate ventricular contractures?
150 bpm
What conditions are associated with Atrial Flutter?
- Hypertension
- Ischaemic heart disease
- Cardiomyopathy
- Thyrotoxicosis
What would you see on an ECG of someone with atrial flutter?
‘sawtooth’ appearance
What does sawtooth appearance on an ECG mean?
P wave after P wave.
What is the medical management of Atrial Flutter?
Rate/rhythm control with beta blockers
Cardioversion
What is the curative management for most patients?
Radiofrequency ablation of the tricuspid valve isthmus
Which atrium is mainly affected by atrial flutter?
Right atrium
What is atrial flutter likely to be caused by?
Pulmonary disease
What pulmonary diseases is atrial flutter associated with?
COPD
Obstructive sleep apnoea
Pulmonary emboli
Pulmonary hypertension
Why are these impulses not transmitted as fast to the ventricles?
AV node has a relatively long refractory period and is not able to conduct impulses down the His-Purkinje system at such a fast rate.
What is the management of atrial flutter in a patient who is haemodynamically unstable?
Direct current synchronised cardioversion
What might indicate that a patient is haemodynamically unstable?
Shock ( end organ hypoperfusion)
Syncope (evidence of brain hypoperfusion)
Chest pain (evidence of myocardial ischaemia)
Pulmonary oedema (evidence of heart failure)
How can atrial flutter be managed if a patient is haemodynamically stable?
Same as AF:
Rate control via BB and CCB
What would you consider if the patient’s atrial flutter isn’t controlled with BB or CCB?
Cardioversion
