Question

• Definition of the chosen disrhythmia .
• How it happens
• Why it happens
• Is is considered serious or not
• Best treatment

Answer 1

#. Atrial flutter :-

A single foci causing a circular re-entry pathway in the ventricles

SA node is suppressed

Atria and ventricular rate are different

Atrial rate can be between 250-300 bpm

Ventricular rate can be 150-250

#. What does atrial flutter look like on an ECG

Saw tooth like p waves

ratio can vary from 2;1 to 3;1 depending on av conduction

atrial rate is fast 250-300 bpm

Ventricular rate slower due to (protective) refractory period

Ventricular rate is normally regular but can be irregular

No p-r interval

No T wave

#. What causes atrial flutter

Severe mitral valve disease (left side of heart)

Hyperthyroidism

Post cardiac surgery

Damage to SA node

#. What are symptoms of atrial flutter

May not be symptomatic if ventricular rate normal

Weak pulse

Cool peripheries

Low CO

Low BP

Palpitations

SOB

DIzziness

#. How do we treat stable atrial flutter

IV beta blocker

Sotalol 1.0 - 1.5 mg/kg in 100mls of N/S or 5% dextrose over 20 minutes

#. How do we recognise if atrial flutter unstable

Systolic < 90 mmHg

Decreased level of consciousness

Chest pain

Heart Disease

#. How do we treat unstable atrial flutter

Synchronised Cardioversion up to 3 times

Amiodaraone 300 mg in 100mls of 5% dextrose in pvc free bag given over 20-60 mins