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ECG: Atrial Flutter
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Transcript

  • 1. ECG of the week
    • Dr. Prof Mageshkumar’s Unit
    • Devendra Patil
  • 2.
    • Daniel , 50 / M came with chief complains of
    • Palpitations since 2 hrs
    • chest pain since 2 hrs
    • ECG was taken:
  • 3.  
  • 4.  
  • 5.
    • ECG:
    • Atrial rate 300
    • Heart rate 75/min
    • Regular rhythm
    • 4:1 constant block
    • No iso electric baseline
    • Saw tooth appearance in inferior leads
    • Rsr’ in v1
    • Impression:
    • Atrial flutter with incomplete RBBB
  • 6. Atrial Flutter
    • Mechanism:
    • macro re-entrant tract in the atria
    • Types:
    • - right / left re-entrant tract
    • - counterclockwise / clockwise tract
    • - typical /reverse typical / atypical
    • - regular / irregular rhythm
    • - isthumus dependent / non dependent (recent)
  • 7. Typical atrial flutter
    • Pathway:
    • 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
    • Tract location :
    • cavo – tricuspid isthumus
  • 8.  
  • 9.
    • ECG Findings:
    • Atrial complexes of constant morphology polarity and cycle length
    • Presence of Flutter ( F ) waves
    • Picket fence appearance of F waves
    • Saw toothed appearance of F waves
    • No iso-electric base line
    • Usually the atrial rate is 300 / min and there is a 2:1 block , so heart rate is 150 / min
    • Typically leads II III and avF show negative F waves
    • Lead V1 shows positive F waves and this may be confused with sinus tachycardia
  • 10.
    • ECG findings:
    • Very rapid Venticular rates makes ECG diagnosis difficult
    • The F waves may superimpose on the terminal QRS and the T waves and make the diagnosis difficult
    • Use of vagal manuovers or Inj. Adenosine to transiently increase the AV delay may unmask the flutter waves
    • Clockwise Atrial flutter:
    • positive waves in inferior leads and V1 shows a biphasic or sometimes negative F waves
  • 11. Few more ECG s
  • 12.  
  • 13.  
  • 14.  
  • 15.  
  • 16. Etiology
    • First week after open heart surgery
    • COPD
    • Mitral or tricuspid valve lesions
    • Thyrotoxicosis
    • Surgical correction of congenital heart disease
    • Right atrial enlergement
  • 17. Treatment
    • Acute:
    • cardioversion
    • Longterm
    • anti-coagulation ( similar to AF )
    • anti-arrhythmics
    • Catheter ablation of tract
    • pacemaker insertion
  • 18. Cardioversion
    • External trans thoracic syncronised DC shock is highly effective
    • Intravenous Ibulitide or procainamide can also be used
    • 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.
  • 19.  
  • 20. Long term treatment