1 00:00:02,720 --> 00:00:04,750 - Now, on an ECG, atrial flutter 2 00:00:04,750 --> 00:00:07,960 resembles sawtooth like F-waves. 3 00:00:07,960 --> 00:00:11,150 This is the result of an ectopic atrial pacemaker 4 00:00:11,150 --> 00:00:13,720 or because of a rapid reentry pathway somewhere 5 00:00:13,720 --> 00:00:18,170 within the atria, albeit outside of the SA node area. 6 00:00:18,170 --> 00:00:20,660 The origin of this ectopic pacemaker 7 00:00:20,660 --> 00:00:23,010 is usually somewhere in the lower atrium 8 00:00:23,010 --> 00:00:25,340 and closer to the AV node 9 00:00:25,340 --> 00:00:28,490 thereby resulting in a distinct wave pattern. 10 00:00:28,490 --> 00:00:30,640 Due to this erratic electrical activity, 11 00:00:30,640 --> 00:00:32,530 the normal function of the SA node 12 00:00:32,530 --> 00:00:34,940 is usually suppressed and non effective. 13 00:00:34,940 --> 00:00:38,920 So, instead of a P-wave, atrial flutter produces flutter, 14 00:00:38,920 --> 00:00:42,470 or, F-waves, as a result of the depolarization 15 00:00:42,470 --> 00:00:45,300 of the atria in an abnormal manner. 16 00:00:45,300 --> 00:00:48,970 The classic F-waves of atrial flutter resemble a sawtooth, 17 00:00:48,970 --> 00:00:51,140 hence why we give it that name. 18 00:00:51,140 --> 00:00:55,070 Now let's take a little closer look at the ECG. 19 00:00:55,070 --> 00:00:57,270 First, we ask ourselves about the rhythm. 20 00:00:57,270 --> 00:01:00,190 Is the rhythm regular or irregular? 21 00:01:00,190 --> 00:01:01,410 In this case, it's variable, 22 00:01:01,410 --> 00:01:05,190 depending on the ratio of F-waves to the QRS complex. 23 00:01:05,190 --> 00:01:07,890 Then we ask ourselves, what is the rate? 24 00:01:07,890 --> 00:01:09,650 The rate is variable. 25 00:01:09,650 --> 00:01:11,990 Is the rate normal, fast, or slow? 26 00:01:11,990 --> 00:01:13,420 In this case, the rate is variable 27 00:01:13,420 --> 00:01:15,590 because of its irregularity. 28 00:01:15,590 --> 00:01:18,350 So next, we evaluate the P-wave. 29 00:01:18,350 --> 00:01:19,910 Are they present? 30 00:01:19,910 --> 00:01:23,010 Are there anything closely resembling a P-wave 31 00:01:23,010 --> 00:01:27,070 or is it just that sawtooth type F-wave? 32 00:01:27,070 --> 00:01:29,210 Other P-wave questions do not apply 33 00:01:29,210 --> 00:01:31,023 when we see the F-wave flutter. 34 00:01:32,470 --> 00:01:35,680 Then we ask ourselves is the PR-Interval normal, 35 00:01:35,680 --> 00:01:37,670 less than 0.20 seconds? 36 00:01:37,670 --> 00:01:40,610 In this case, no, because it's variable. 37 00:01:40,610 --> 00:01:42,470 And there are no P-waves. 38 00:01:42,470 --> 00:01:46,090 So now we move on the QRS complex of the ECG. 39 00:01:46,090 --> 00:01:49,770 Is the QRS interval less than 0.09 seconds? 40 00:01:49,770 --> 00:01:51,160 The answer is yes. 41 00:01:51,160 --> 00:01:53,840 The QRS is within normal range. 42 00:01:53,840 --> 00:01:56,420 Then we ask is the QRS wide or narrow? 43 00:01:56,420 --> 00:01:59,890 And in this case, the QRS is narrow. 44 00:01:59,890 --> 00:02:02,810 Are the QRS complexes similar in appearance? 45 00:02:02,810 --> 00:02:06,200 And we can see that each one looks similar. 46 00:02:06,200 --> 00:02:09,730 So now, what is our cardiac interpretation? 47 00:02:09,730 --> 00:02:11,250 Structural heart disease 48 00:02:11,250 --> 00:02:13,640 is the usual cause of atrial flutter. 49 00:02:13,640 --> 00:02:16,120 It can develop in newborn infants with normal hearts 50 00:02:16,120 --> 00:02:18,630 and in children with congenital heart disease, 51 00:02:18,630 --> 00:02:21,100 especially after cardiac surgery. 52 00:02:21,100 --> 00:02:23,220 In the same way that atrial fibrillation 53 00:02:23,220 --> 00:02:26,280 complicates adequate ventricular preload filling, 54 00:02:26,280 --> 00:02:28,330 atrial flutter complicates circulation 55 00:02:28,330 --> 00:02:31,000 especially when accompanied by a syndrome called 56 00:02:31,000 --> 00:02:33,180 rapid ventricular response. 57 00:02:33,180 --> 00:02:34,860 The faster the ventricular response, 58 00:02:34,860 --> 00:02:37,283 the more the circulation will be compromised.