ATRIAL  FLUTTER

Etiology:
1. CAD, MI,  TSH, PE, COPD, RH, CHF, ASD. As compare to A.fib, the A.flut is not seen in
normal heart.

S & S:
1. Pt may experience palpitations/tachycardia only or may have more unstable
 vital signs (e.g. CHF).

2. Pt may c/o chest pain due to ischemia induced by tachycardia or dyspnea if
CHF occurred

DX:

• Atrial rate 250-350 b/min
• "sawtooth" pattern in II, III, aVF.
• Atrial-to-Ventricle conduction may  vary (1:1, 2:1, 3:1). The 1:1 block
  may be hard to distinguish from VF. The 2:1 block will present with HR
  of 150 or somewhere very close to it  (145, 140). A.flut with  3:1 block
  will have ventricular rate of 100 b/min.
• IfA.flut presents with variable block it may be difficult to distinguish from
  A.fib. Additionally, these two rhythms may coexist leading to common
  presentation of "Fib-Flut"
   

Treatment:

1. Hemodynamically stable - dig, CCB or -blockers as in case of A.fib
 (see above) are given to achieve control and to prevent rapid ventricular
 response. Carotid massage can be tried.

2. Hemodynamically unstable or having S & S of ischemia, SOB, MI – sync.
cardioversion with 25-50 J is tried initially and then 100-200-300J.

3. Although the risk of thromboembolism is less than in case of A.fib, the risk is
nonetheless higher than in pts with NSR. Thus, same approach as in case of A.fib (i.e. cardioversion if the duration is less than 48 hrs or anticoagulation for 3-4 wks if more
than 48hrs) is recommended.

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