Atrial Flutter

Question 1

What is atrial flutter. (2)

Answer 1

Atrial re-entry tachycardia, leading to a rapid atrial rate. ( approximately 300beats/min).
Usually occurs with a slower ventricular rate due to 2:1 or 3:1 block in the AV node.

Question 2

What is the atrial rate in atrial flutter.

Answer 2

Approximately 300BPM.

Question 3

What are the principal types of AV block found in atrial flutter (2)

Answer 3

2: 1.
3: 1.

Question 4

What are the symptoms of atrial flutter. (3)

Answer 4

Palpitations.
Dizziness.
Heart failure.

Question 5

What are the main causes of atrial flutter. (2)

Answer 5

Acute cardiac or respiratory problems. (eg pericarditis, pneumonia).

Question 6

What are the clinical signs of atrial flutter. (2)

Answer 6

Tachycardia, with or without haemodynamic compromise.

Question 7

What is typically seen on the ECG of a patient with atrial flutter. (2)

Answer 7

Characteristic sawtooth pattern.

With AV block.

Question 8

What is the main investigation for a patient with atrial flutter.

Answer 8

ECG.

Question 9

What are the two main aspects of treatment of atrial flutter. (2)

Answer 9

Rate control.

Curative.

Question 10

What drug groups are used for rate control in atrial flutter. (2)

Answer 10

Anti-arrhythmics.

Anticoagulation.

Question 11

What are the curative methods of treating atrial flutter. (4)

Answer 11

DC cardioversion (anticoagulant before).
Anti-AF drugs might not work, but consider amiodarone to restore sinus rhythm, and amiodarone or sotalol to maintain it (if IV route is needed, a beta blocker might be preferred). 
Catheter ablation of aberrant pathway.

Question 12

If you are unsure if a patient is suffering from atrial flutter, what two things might unmask the sawtooth waves on an ECG. (2)

Answer 12

Carotid sinus massage.

IV adenosine.