Atrial flutter

Question 1

What is atrial flutter caused by?

Answer 1

Re-entrant circuit that travels in counter-clockwise direction.

Question 2

What kind of rhythm is atrial flutter?

Answer 2

Regularly irregular (too many P waves)

Question 3

What are the symptoms of atrial flutter?

Answer 3

-dizziness
-palps
-SOB

Question 4

Where are the P waves?

Answer 4

Always one buried in the QRS!

Question 5

What is the rate of flutter?

Answer 5

250-350bpm

Question 6

What do course flutter waves suggest?

Answer 6

Newish onset

Question 7

What do fine flutter waves suggest?

Answer 7

Long-standing

Question 8

Since the ventricles aren’t affected, what does the ECG show?

Answer 8

Still R wave progression seen

Question 9

Impulse is counter-clockwise in RA, what are the polarities in the leads?

Answer 9

-F waves negative in inferior (II, III and aVF)
-low amplitude in I
-positive in V1

Question 10

What is the ventricular response determined by?

Answer 10

Conducting ability of AV junction

Question 11

What gives a higher degree of AV block?

Answer 11

-AV nodal blocking drugs
-Impaired AV function
-High vagal tone

Question 12

What happens to AV conduction when the sympathetic NS is activated?

Answer 12

Enhance AV nodal conduction therefore 1:1 conduction
Ventricular rate is 300bpm

Question 13

How could you aid a diagnosis of atrial flutter?

Answer 13

-carotid sinus massage
-adenosine