![]() ![]() ![]() This patient was given a Diltiazem bolus and then placed on a drip which improved his rate into the 80s, although he was still in 2:1 atrial flutter. If the patient is stable, the first priority is to achieve ventricular rate control with beta-blockers or nondihydropyridine calcium channel blockers. In general, patients with right heart disease are more likely to get atrial flutter rather than atrial fibrillation, however “where there’s fib, there’s flutter” and these patients can exhibit episodes of a.fib as well. This patient’s atrial flutter is most likely a result of his severe cor pulmonale, his right atria and ventricle were found to be massively dilated on echocardiogram, predisposing patient to atrial flutter. It is not uncommon for patients in atrial flutter to present with edema due the lack of forward flow through the heart secondary to atrial flutter. ![]() Narrow-complex tachycardia at a rate of 130-170: suspect flutter!!Ītrial flutter was the cause of this patient’s severe lower extremity edema extending to the scrotum and pre-sacral level. Pro-tip: If you ever have difficulty distinguishing the buried P-waves of atrial flutter, you can block down the AV node with vagal maneuvers or Adenosine and the slowing of the ventricular rate will unmask the underlying atrial rhythm. Atrioventricular block – usually at 2:1, but occasionally greater, associated with ventricular rate between 125-175 bpm.Sawtooth flutter waves – directed superiorly and most visible in leads II, III, and aVF.Regular atrial rate – between 250-350 bpm.Typical characteristics of atrial flutter: ![]()
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