Atrial flutter
Cardiology (12%) Core Clinical Conditions
1B: Able to identify the condition as a possible diagnosis: may not have the knowledge or resources to confirm the diagnosis or to manage the condition safely, but can take measures to avoid immediate deterioration and refer appropriately
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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management
Definition
Atrial flutter is an abnormal heart rhythm (arrhythmia) characterised by rapid and regular atrial contractions of the heart. A normal heart rhythm begins in the right atrium at the SA node, and the signal travels to both atria in an orderly fashion. In atrial flutter, however, the normal electrical signal is disrupted and a new, circular electrical signal forms in its place. This causes rapid and regular contraction of the atria, while the ventricles are unable to pump blood as quickly as the atria, resulting in cardiac strain and decreased cardiac output. The result is a heart rate of 150 to 300, as opposed to the normal 60 to 100.
Aetiology
Structural causes: Heart failure, valvular heart disease, and congenital heart defects. These can lead to scarring or dilation of the atria and promote the development of atrial flutter.
Complication after Heart surgery: Atrial flutter can occur after heart. The procedure might have caused scarring or damage to the heart.
Other medical conditions: thyroid disease, chronic obstructive pulmonary disease (COPD), and sleep apnea.
Substance abuse
Idiopathic: no known cause
Pathophysiology
Abnormal electrical activity in the right atrium which creates a rapid and regular electrical impulse that overrides the normal electrical activity of the heart.
Rapid and irregular atrial contraction leading to increased and irregular heart rate.
Reduced cardiac output: poor blood flow to the body.
Blood pooling and increased risk of thrombus (blood clot) formation
Risk factors
Older age
Heart disease such as heart failure, or congenital heart defects
Previous heart surgery
Other medical conditions: thyroid disease, chronic obstructive pulmonary disease (COPD), and sleep apnea.
Substance abuse
Family history of atrial flutter
Obesity and sedentary lifestyle
Sign and symptoms
Tachycardia hr around 150-300 bpm
SOB
Fatigue
Chest pain
Dizziness
Syncope
Investigations
ECG (see figure 1)
24/48 ECG
ECHO
Bloods - rule out thyroid disease
CXR to detect any fluid accumulation in the lungs
Cardiac MRI - check heart structure
Figure 1
The ECG shows a regular, sawtooth-like pattern.
Management
Similar treatment of AF:
Heart rate control medications such as beta blockers (such as metoprolol, carvedilol), calcium channel blockers (such as metoprolol, carvedilol), and antiarrhythmic medicines such as digoxin
Electrical Cardioversion
Ablation
Pacemaker (if ablation fails)
Prevention of thromboembolism with appropriate anticoagulation
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