{"id":7883,"date":"2013-03-07T22:22:26","date_gmt":"2013-03-08T03:22:26","guid":{"rendered":"http:\/\/insidesurgery.com\/?p=7883"},"modified":"2013-03-13T11:56:56","modified_gmt":"2013-03-13T15:56:56","slug":"atrial-flutter","status":"publish","type":"post","link":"https:\/\/insidesurgery.com\/2013\/03\/atrial-flutter\/","title":{"rendered":"Atrial Flutter"},"content":{"rendered":"

Pathophysiology of Atrial Flutter<\/h4>\n

atrial flutter is:<\/p>\n

1)<\/strong>\u00c2\u00a0 a rapid heart beat with a regular rhthm
\n2)<\/strong> causes include corrective surgery for congenital heart disease, mitral valve disease, and cardiomyopathy<\/p>\n

\"atrial<\/a><\/p>\n

Type 1 atrial flutter (classic)<\/em><\/p>\n

3)<\/strong> electrical pathway goes through the subeustachian isthmus with flutter traveling in a counterclockwise manner (rate usually 280-320 atrial beats per minute<\/p>\n

Type 2 atrial flutter<\/em><\/p>\n

4)<\/strong> faster rate (340-350 atrial beats per minute)<\/p>\n

<\/p>\n

Characteristic Test Findings<\/h4>\n

ECG – Type 1 atrial flutter has a sawtooth pattern in inferior leads (II, III, and aVF) and V1 has discrete flutter waves<\/p>\n

Associated Conditions<\/h4>\n

1)<\/strong> corrective surgery for atrial septal defects, tetralogy of Fallot, and great vessel transposition
\n2)<\/strong> thyrotoxicosis
\n3)<\/strong> pulmonary embolus
\n4)<\/strong> mitral stenosis
\n5)<\/strong> pericarditis<\/a>
\n6)<\/strong> acute respiratory failure
\n7)<\/strong> atrial fibrillation
\n8)<\/strong> sinoatrial node dysfunction<\/p>\n

Inheritance and Epidemiology<\/h4>\n

atrial flutter can occasionally occur in normal individual but most common in children and adults who have undergone corrective surgery<\/p>\n

Treatment<\/h4>\n

Clinically stable patient<\/em><\/p>\n

1)<\/strong> give digitalis to slow ventricular rate before giving a class IA antiarrhythmic (e.g., quinidine)
\n2)<\/strong> calcium channel blockers (e.g., verapamil or diltiazem)<\/p>\n

Clinically unstable patient (or if in 1:3 or 1:4 block<\/em>)<\/p>\n

3)<\/strong> should cardiovert starting at 50 J
\n4<\/strong>) rapid atrial pacing with concomitant use of beta blockers
\n5)<\/strong> ibutilide (must watch closely for conversion to torsades de pointes
\n6)<\/strong> amioadarone
\n7)<\/strong> radiofrequency ablation if condition is chronic
\n8)<\/strong> anticoagulation – use only if condition is of long-term duration and refractory to treatment<\/p>\n

Tips for USMLE<\/h4>\n

1)<\/strong> responding ventricular rate is usually expressed as ratio of atrial rate (e.g., 2:1, which means the ventricles are beating at 150 bpm); thus a narrow QRS at 150 bpm is likely to be atrial flutter
\n2)<\/strong> carotid sinus massage does not interrupt atrial flutter but will cause a temporary AV block and will transiently drop the heart rate from 150 to 75 bpm (this parasympathetic stimulus drops ventricular rate and increased atrial rate); thus carotid massage can be used to help make diagnosis
\n3)<\/strong> if ECG shows “sawtooth” tracing think atrial flutter
\n4)<\/strong> atrial flutter is rapid rate, regular rhythm; atrial fibrillation is rapid rate, irregular rhythm<\/p>\n","protected":false},"excerpt":{"rendered":"

Pathophysiology of Atrial Flutter atrial flutter is: 1)\u00c2\u00a0 a rapid heart beat with a regular rhthm 2) causes include corrective surgery for congenital heart disease, mitral valve disease, and cardiomyopathy Type 1 atrial flutter (classic) 3) electrical pathway goes through the subeustachian isthmus with flutter traveling in a counterclockwise manner (rate usually 280-320 atrial beats […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[5080,63,11],"tags":[],"yoast_head":"\nAtrial Flutter - 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