Atrial Flutter (SVT)

Question 1

What is Atrial flutter

Answer 1

Organised atrial rhythm of 300bpm caused by a macro circuit in the right atrium

Question 2

What role does the macro circuit play in flutter

Answer 2

It restarts the Conduction loop rapidly at the AV node but due to its long refractory time there is inconsitency in conduction to bundle of His and purkinge fibres and blocked atrial impulses head to the ventricles

Question 3

What are the causes of flutter

Answer 3

Idiopathic
Pulmonary (Most common)
-COPD
-PE
-Pulmonary HTN
IHD
Sepsis
Alcohol
Cardiomyopathy

Question 4

Wat are the symptoms of flutter

Answer 4

Asymptomatic
Palpitations
Dizzy 
SOB
Chest pain

Question 5

What is the ECG presentation of Flutter

Answer 5

Regular rhythm with "Saw tooth" (F wave)
300bpm
Narrow QRS
Ventricular rate decreases with increased AV Block
2:1 Heart block

Question 6

What is the first line management of flutter

Answer 6

Same as AF
Electrical Cardioversion
Pharmacological Cardioversion
Rate control
Ablation

Question 7

What should be done to a haemodynamically unstable flutter patient

Answer 7

DC Cardioversion

Question 8

What are the signs of Haemodynamic instability

Answer 8

Shock (End organ hypoperfusion)
Syncope (Brain hypoperfusion)
Chest pain (Myocardial ischemia)
Pulmonary oedema (Heart fail)

Question 9

How would you manage a haemodynamically stable patient

Answer 9

Treat reversible causes such as sepsis and dehyrdation with IV fluids
Rate control with BB/CCB
If rate control fails attempt cardioversion

Question 10

How would you manage recurring flutter

Answer 10

Catheter ablation of the cavotricuspid isthmus

Question 11

Would you give anticoagulation in Flutter

Answer 11

YES, Follow CHADS2VASc

Chance of thromboembolism leading to a stroke