Beware of any HR that is 150 +/- 20, if it’s not responding to fluids or other therapy it very well be flutter - Amal Mattu


image by: DHO Premier Medical Service

HWN Suggests

Is This Sinus?

If you ever have difficulty distinguishing the buried P-waves of atrial flutter, you can block down the AV node with vagal maneuvers or Adenosine and the slowing of the ventricular rate will unmask the underlying atrial rhythm. Narrow-complex tachycardia at a rate of 130-170: suspect flutter!!

If the patient is stable, the first priority is to achieve ventricular rate control with beta-blockers or nondihydropyridine calcium channel blockers. This patient was given a Diltiazem bolus and then placed on a drip which improved his rate into the 80s, although he was still in 2:1 atrial flutter.

Long-term management options for stable patients can be divided into rate control…

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 Is This Sinus?

he patient presents in 2:1 atrial flutter with a ventricular rate of 156, meaning that the atria are firing at a rate 2 times faster (approximately 312). The extra P-waves give the EKG baseline the typical “sawtooth” appearance of atrial flutter.

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