ECG   of the week  <ul><li>Dr. Prof Mageshkumar’s Unit  </li></ul><ul><li>Devendra Patil </li></ul>
<ul><li>Daniel , 50 / M came with chief complains of  </li></ul><ul><li>Palpitations  since 2 hrs </li></ul><ul><li>chest ...
 
 
<ul><li>ECG: </li></ul><ul><li>Atrial rate 300 </li></ul><ul><li>Heart rate 75/min </li></ul><ul><li>Regular rhythm </li><...
Atrial Flutter <ul><li>Mechanism: </li></ul><ul><li>macro re-entrant tract in the atria </li></ul><ul><li>Types: </li></ul...
Typical atrial flutter <ul><li>Pathway: </li></ul><ul><li>in the typical form the re-entrant wavefront moves from up in th...
 
<ul><li>ECG Findings: </li></ul><ul><li>Atrial complexes of constant morphology polarity and cycle length </li></ul><ul><l...
<ul><li>ECG findings: </li></ul><ul><li>Very rapid Venticular rates makes ECG diagnosis difficult </li></ul><ul><li>The F ...
Few more  ECG s
 
 
 
 
Etiology <ul><li>First week after open heart surgery </li></ul><ul><li>COPD </li></ul><ul><li>Mitral or tricuspid valve le...
Treatment <ul><li>Acute: </li></ul><ul><li>cardioversion </li></ul><ul><li>Longterm </li></ul><ul><li>anti-coagulation ( s...
Cardioversion <ul><li>External trans thoracic syncronised DC shock is highly effective </li></ul><ul><li>Intravenous Ibuli...
 
Long term treatment
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ECG: Atrial Flutter

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ECG: Atrial Flutter

  1. 1. ECG of the week <ul><li>Dr. Prof Mageshkumar’s Unit </li></ul><ul><li>Devendra Patil </li></ul>
  2. 2. <ul><li>Daniel , 50 / M came with chief complains of </li></ul><ul><li>Palpitations since 2 hrs </li></ul><ul><li>chest pain since 2 hrs </li></ul><ul><li>ECG was taken: </li></ul>
  3. 5. <ul><li>ECG: </li></ul><ul><li>Atrial rate 300 </li></ul><ul><li>Heart rate 75/min </li></ul><ul><li>Regular rhythm </li></ul><ul><li>4:1 constant block </li></ul><ul><li>No iso electric baseline </li></ul><ul><li>Saw tooth appearance in inferior leads </li></ul><ul><li>Rsr’ in v1 </li></ul><ul><li>Impression: </li></ul><ul><li>Atrial flutter with incomplete RBBB </li></ul>
  4. 6. Atrial Flutter <ul><li>Mechanism: </li></ul><ul><li>macro re-entrant tract in the atria </li></ul><ul><li>Types: </li></ul><ul><li>- right / left re-entrant tract </li></ul><ul><li>- counterclockwise / clockwise tract </li></ul><ul><li>- typical /reverse typical / atypical </li></ul><ul><li>- regular / irregular rhythm </li></ul><ul><li>- isthumus dependent / non dependent (recent) </li></ul>
  5. 7. Typical atrial flutter <ul><li>Pathway: </li></ul><ul><li>in the typical form the re-entrant wavefront moves from up in the interatrial septum and then down the free right atrial wall. i.e. counterclockwise </li></ul><ul><li>Tract location : </li></ul><ul><li>cavo – tricuspid isthumus </li></ul>
  6. 9. <ul><li>ECG Findings: </li></ul><ul><li>Atrial complexes of constant morphology polarity and cycle length </li></ul><ul><li>Presence of Flutter ( F ) waves </li></ul><ul><li>Picket fence appearance of F waves </li></ul><ul><li>Saw toothed appearance of F waves </li></ul><ul><li>No iso-electric base line </li></ul><ul><li>Usually the atrial rate is 300 / min and there is a 2:1 block , so heart rate is 150 / min </li></ul><ul><li>Typically leads II III and avF show negative F waves </li></ul><ul><li>Lead V1 shows positive F waves and this may be confused with sinus tachycardia </li></ul>
  7. 10. <ul><li>ECG findings: </li></ul><ul><li>Very rapid Venticular rates makes ECG diagnosis difficult </li></ul><ul><li>The F waves may superimpose on the terminal QRS and the T waves and make the diagnosis difficult </li></ul><ul><li>Use of vagal manuovers or Inj. Adenosine to transiently increase the AV delay may unmask the flutter waves </li></ul><ul><li>Clockwise Atrial flutter: </li></ul><ul><li>positive waves in inferior leads and V1 shows a biphasic or sometimes negative F waves </li></ul>
  8. 11. Few more ECG s
  9. 16. Etiology <ul><li>First week after open heart surgery </li></ul><ul><li>COPD </li></ul><ul><li>Mitral or tricuspid valve lesions </li></ul><ul><li>Thyrotoxicosis </li></ul><ul><li>Surgical correction of congenital heart disease </li></ul><ul><li>Right atrial enlergement </li></ul>
  10. 17. Treatment <ul><li>Acute: </li></ul><ul><li>cardioversion </li></ul><ul><li>Longterm </li></ul><ul><li>anti-coagulation ( similar to AF ) </li></ul><ul><li>anti-arrhythmics </li></ul><ul><li>Catheter ablation of tract </li></ul><ul><li>pacemaker insertion </li></ul>
  11. 18. Cardioversion <ul><li>External trans thoracic syncronised DC shock is highly effective </li></ul><ul><li>Intravenous Ibulitide or procainamide can also be used </li></ul><ul><li>Care should be taken during use of class 1 esp 1C agents because they may slow the atrial rate and an inadequately suppressed AV node may give way to 1:1 conduction leading to high rates and circulatory collapse. </li></ul>
  12. 20. Long term treatment
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