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Atrial Flutter with a High Degree Block

atrial flutter clinical cases podcast Mar 27, 2024
EM Mastery
Atrial Flutter with a High Degree Block
2:08
 

A 78yo male woke up in the morning feeling dizzy. The patient was well when lying down, but became light headed every time he got up. He waited, but symptoms did not improve, so later in the afternoon he attended the Care Centre. 

Not all the past history is available, but there is a history of CAGS and atrial fibrillation/flutter for which he was on Diltiazem.
The patient was alert and well and there was no chest pain or SOB. The blood pressure was 130/80 and the heart rate was… as you see below. What does the ECG show? What is the diagnosis and what do you do now?

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Atrial Flutter

 

Second most common arrhythmia we will see, after atrial fibrillation
It is macroreentrant atrial tachycardia with the loop above the AV node in the right atrium. Complexes are narrow.
  • type 1 flutter is the most frequent. In this type of flutter, right atrial activation rotates in a counterclockwise direction
It usually produces a narrow complex tachycardia, with a classic sawtooth pattern best seen in lead II, although many prefer V1 as the best lead to look at p waves.
The AVN cannot conduct at the same rate (240-360) as the flutter, so have a

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