In typical atrial flutter a single electrical circuit loops around the right atrium about 300 times a minute, and the AV node usually lets every second beat through, giving a regular pulse near 150. Like atrial fibrillation it raises stroke risk, and it is often cured by catheter ablation.
Key symptoms
- Palpitations or a fast, regular heartbeat
- Shortness of breath
- Fatigue and less exercise tolerance
- Lightheadedness or fainting
- Chest discomfort
What you find on exam
- Regular fast pulse, often about 150 beats per minute
- Blood pressure and signs of poor perfusion
- Flutter waves sometimes seen in the neck veins
- Signs of heart failure: crackles, edema
Tests
- 12-lead ECG: sawtooth flutter waves in II, III and aVF
- Vagal maneuvers or adenosine can slow the rate to reveal flutter waves
- Thyroid tests, electrolytes, kidney function
- Echocardiogram for structure and pump function
- CHA2DS2-VASc score for stroke risk
Treatment basics
- Unstable patient: synchronized cardioversion, often effective at low energy
- Rate control with a beta blocker or diltiazem
- Anticoagulation by stroke risk, same rules as atrial fibrillation
- Catheter ablation of the cavotricuspid isthmus for typical flutter
- Treat triggers such as lung disease, thyroid disease or recent surgery
Red flags
- Low blood pressure, chest pain or confusion
- Sudden weakness or trouble speaking
- Signs of new heart failure
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.