ecg: a case of flutter-fibrillation
TRANSCRIPT
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ECG OF THE WEEK.
PROF .DR.P.VIJAYARAGHAVAN’S UNIT.
DR.A.KARTHICK RAMALINGAM.
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Clinical summary.
• 70 year old Mrs. Devasundari was admitted with
C/o Chest pain, Palpitation,
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ECG FINDINGS
• Atrial rate 340/min• Ventricular Rate 60/ min.• Axis +60.• P waves having morphology intermediate
between that of flutter and fibrillation waves.
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• Rhythm strip shows flutter/fibrillation waves • No ST , T wave abnormalities seen .• IMP: – Flutter - fibrillation– Atrial flutter is of type I . (Flutter waves are of
uniform morphology)– Clockwise conduction. (Positive F wave II,III,aVF).
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Atrial flutter
• It’s a supraventricular tachycardia caused by reentrant rhthym either in left or right atrium.
• Atrial rate will be around 240 to 400/ min.• Two types: Type 1 or classic form is more common.
Involves a single reentrant circuit . Type II (atypical) Atypical atrial flutters .
Has a rate faster than type I
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TYPE I FLUTTER
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TYPE I FLUTTER
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Anticlockwise and Clockwise
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OTHER REENTRANT CIRCUITS
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Treatment
• General goals for the treatment of symptomatic atrial flutter are similar to those for atrial fibrillation and include the following:
• Control of the ventricular rate• Restoration of sinus rhythm• Prevention of recurrent episodes, or decrease in
their frequency or duration• Prevention of thromboembolic complications• Minimization of adverse effects from therapy
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TYPE I FLUTTER• If pt is clinically stable : consider ventricular rate
control and elective ablative therapy of the circuit.
• If pt is hemodynamically compromised : cardioversion immediately or after anticoagulation depending on duration of A. flutter followed by elective abalative therapy. ELECTRICAL CARDIOVERSION IS PREFFERED
• Post ablation pt may or maynot nead antiarrythymics depending on effectiveness of ablation.
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TYPE II FLUTTER
• Ablation can be done in higher centers with facilities to map the circuit .
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CATHETER ABLATION
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THANK YOU