NationMaster - Encyclopedia: Atrial flutter

Atrial flutter is an abnormal fast heart rhythm that occurs in the atria of the heart. This rhythm occurs most often in individuals with organic heart disease (ie: pericarditis, coronary artery disease, and cardiomyopathy). The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // I00-I99 - Diseases of the circulatory system (I00-I02) Acute rheumatic fever (I00) Rheumatic fever without mention of heart involvement (I01) Rheumatic fever with heart involvement (I02) Rheumatic chorea (I05-I09) Chronic rheumatic heart diseases (I05) Rheumatic mitral valve diseases (I050) Mitral stenosis (I051) Rheumatic mitral insufficiency (I06) Rheumatic aortic... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... In anatomy, the atrium (plural: atria) is the blood collection chamber of a heart. ... The heart and lungs, from an older edition of Grays Anatomy. ... Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ... Coronary heart disease (CHD), also called coronary artery disease (CAD) and atherosclerotic heart disease, is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). ...

Atrial flutter is typically not a stable rhythm, and frequently degenerates to atrial fibrillation. However, it may persist for months to years. Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). ...

Symptoms

While atrial flutter can sometimes go unnoticed, its onset is often marked by characteristic sensations of rapid regular thumping in the chest and palpitations. Such sensations usually last until the episode resolves, or until the heart rate is controlled. This article does not cite any references or sources. ...

Atrial flutter is usually well tolerated initially (fast heart beat is for most people, just a normal response to exercise), however, people with other underlying heart disease or poor exercise tolerance may rapidly develop symptoms, which can include shortness of breath, chest pains, lightheadedness or dizziness, nausea and, in some patients, nervousness and feelings of impending doom.

Prolonged fast flutter may lead to decompensation and loss of normal heart function (heart failure). This may manifest as effort intolerance (exertional breathlessness), nocturnal breathlessness, or swelling of the legs or abdomen.

Mechanism of action

Atrial flutter is caused by a reentrant rhythm in either the right or left atrium. Typically initiated by a premature electrical impulse arising in the atria, atrial flutter is propogated due to differences in refractory periods of atrial tissue. This creates a loop of reentry moving around the atrium. Recent studies have shown that patients with typical atrial flutter demonstrate longer refractory periods in the lower right atrial tissue. Cardiac arrhythmia is a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ...

Types of atrial flutter

There are two types of atrial flutter, known as type I and type II.¹ Most individuals with atrial flutter will manifest only one of these types of atrial flutter. Rarely someone may manifest both types of flutter; however, they can only manifest one type at a time.

Type I flutter

Type I atrial flutter, also known as common atrial flutter or typical atrial flutter, has an atrial rate of 240 to 350 beats/minute. However, this rate may be slowed by antiarrhythmic agents. Image File history File links No higher resolution available. ... Image File history File links No higher resolution available. ... The atrioventricular node (abbreviated AV node) is the tissue between the atria and the ventricles of the heart, which conducts the normal electrical impulse from the atria to the ventricles. ... Antiarrhythmic agents are a group of pharmaceuticals that are used to suppress fast rhythms of the heart (cardiac arrhythmias), such as atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation. ...

Type I flutter can be entrained by rapid atrial beating. This means that the re-entrant rhythm of the flutter can be broken if a stimulus enters the re-entrant cycle at just the right point, breaking the cycle and thereby terminating the atrial flutter. While this can be performed with a pacemaker, it is performed almost exclusively in the electrophysiology lab by pacing the atrium at a rate just above the rate of the atrial flutter. While entrainment may break atrial flutter and cause the individual to revert to a normal sinus rhythm, the rapid atrial pacing may cause the individual to go into atrial fibrillation. Type I atrial flutter is increasingly easy to cure in the electrophysiology lab due to its dependence on a fixed anatomic structure known as the isthmus. The isthmus is a body of fibrous tissue that makes up a portion of the reentrant loop. Catheter ablation of the isthmus prevents reentry, and terminates atrial flutter if successful. A pacemaker A pacemaker (or artificial pacemaker, so as not to be confused with the hearts natural pacemaker) is a medical device designed to regulate the beating of the heart. ... Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). ...

Type I flutter has two subtypes, known as counterclockwise atrial flutter and clockwise atrial flutter.

Counterclockwise atrial flutter

Counterclockwise atrial flutter (known as cephalad-directed atrial flutter) is more commonly seen than clockwise atrial flutter. The flutter waves in this rhythm are inverted in II, III, and aVF.

Clockwise atrial flutter

Clockwise atrial flutter is less common than counterclockwise atrial flutter. The flutter waves are upright in II, III, and aVF in this rhythm.

Type II flutter

Type II flutter is faster than type I flutter, and usually is 340–430 beats/minute.

Unlike type I flutter, the rhythm of type II flutter cannot be entrained by rapid atrial pacing.

Complications

Clot formation

In atrial flutter, as in atrial fibrillation, there is no effective contraction of the atria. In individuals with structural heart disease, this causes stasis of blood in the atria. The stasis of blood leads to formation of thrombus material (clots) within the heart. In the left side of the heart, thrombus is most likely for form in the left atrial appendage. This is important because, since the left side of the heart supplies blood to the entire body, any thrombus material that dislodges from the left side of the heart can potentially embolize to the brain, causing a stroke. Of course, the thrombus material can also embolize to any other portion of the body. Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). ... In anatomy, the atrium (plural: atria) is the blood collection chamber of a heart. ... Blood clot diagram. ... In medicine, an embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body. ... Stroke (or cerebrovascular accident or CVA) is the clinical designation for a rapidly developing loss of brain function due to an interruption in the blood supply to all or part of the brain. ...

Sudden death

Sudden death is not directly associated with atrial flutter. However, in individuals with a pre-existing accessory conduction pathway, such as the bundle of Kent in Wolff-Parkinson-White syndrome, the accessory pathway may conduct activity from the atria to the ventricles much faster than the AV node. In this case, the atrial rate of 300 beats/minute will lead to a ventricular rate of 300 beats/minute. If the ventricles are unable to sustain such high ventricular rates, 1:1 flutter may degenerate into ventricular fibrillation, causing hemodynamic collapse and death. Bundle of Kent is an extra or accessory conduction pathway between the atria and ventricles in the heart. ... Wolff-Parkinson-White syndrome (WPW) is a syndrome of pre-excitation of the ventricles of the heart due to an accessory pathway known as the Bundle of Kent. ... Ventricular fibrillation (V-fib or VF) is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. ... This article or section does not adequately cite its references or sources. ...

Treatment

In general, atrial flutter should be treated the same as atrial fibrillation. Because both rhythms can lead to the formation of thrombus material in the atria, individuals with atrial flutter usually require some form of anticoagulation or anti-platelet agent. Additionally, a couple of treatment considerations exist that are particular to individuals with atrial flutter. Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). ... Blood clot diagram. ...

Ablation

Because of the reentrant nature of atrial flutter, it is possible to ablate the circuit that causes atrial flutter. This is done in the electrophysiology lab by causing a ridge of scar tissue that crosses the path of the circuit that causes atrial flutter. Ablation of the isthmus, as discussed above, is a common treatment for typical atrial flutter.

Rate control

Control of the ventricular rate in atrial flutter may be more difficult than if the individual was in atrial fibrillation. This is because of properties of the AV node. In atrial fibrillation, the AV node is typically bombarded with signals from the atria at rates in excess of 400 beats/minute. This causes a high degree of block within the AV node, with many signals partially penetrating the node and blocking at the lower levels of the AV node. This phenomenon is known as concealed conduction. The AV node has decremental properties, such that it will permit more electrical signals to pass through at lower frequences. Therefore, in atrial flutter, on the other hand, the AV node receives signals very rhythmically at a rate of about 300/minute compared to > 400/minute in fibrillation. Since the atrial flutter is an organized rhythm of the atria, the block at the AV node will be consistently at the same level, and paradoxically a higher number of impulses will get through per minute. The atrioventricular node (abbreviated AV node) is the tissue between the atria and the ventricles of the heart, which conducts the normal electrical impulse from the atria to the ventricles. ...

References

External Links

See also

Category: Cardiac electrophysiology Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). ... Diagram of the human circulatory system. ... Pathology (from Greek pathos, feeling, pain, suffering; and logos, study of; see also -ology) is the study of the processes underlying disease and other forms of illness, harmful abnormality, or dysfunction. ... This article does not cite any references or sources. ... In kidney, as a result of benign arterial hypertension, hyaline (pink, amorphous, homogeneous material) accumulates in the wall of small arteries and arterioles, producing the thickening of their walls and the narrowing of the lumens - hyaline arteriolosclerosis. ... While most forms of hypertension have no known underlying cause (and are thus known as essential hypertension or primary hypertension), in about 10% of the cases, there is a known cause, and thus the hypertension is secondary hypertension (or, less commonly, inessential hypertension). ... Renovascular hypertension (or renal hypertension) is a form of secondary hypertension. ... It has been suggested that this article or section be merged with Coronary heart disease. ... Prinzmetals angina, also known as variant angina or angina inversa, is a syndrome typically consisting of angina (cardiac chest pain) at rest that occurs in cycles. ... Acute myocardial infarction (AMI or MI), more commonly known as a heart attack, is a disease state that occurs when the blood supply to a part of the heart is interrupted. ... Dresslers syndrome is a form of pericarditis that occurs in the setting of injury to the heart or the pericardium (the outer lining of the heart). ... Pulmonary circulation is the portion of the cardiovascular system which carries oxygen-depleted blood away from the heart, to the lungs, and returns oxygenated blood back to the heart. ... Cor pulmonale is a medical term used to describe a change in structure and function of the right ventricle of the heart as a result of a respiratory disorder. ... The pericardium is a double-walled sac that contains the heart and the roots of the great vessels. ... Pericarditis is inflammation of the sac surrounding the heart, the pericardium. ... Cardiac tamponade, also known as pericardial tamponade, is a medical emergency condition where liquid accumulates in the pericardium in a relatively short time. ... In the heart, the endocardium is the innermost layer of tissue that lines the chambers of the heart. ... Grays Fig. ... Endocarditis is an inflammation of the inner layer of the heart, the endocardium. ... Mitral regurgitation (MR), also known as mitral insufficiency, is the abnormal leaking of blood through the mitral valve, from the left ventricle into the left atrium of the heart. ... Mitral valve prolapse (MVP) is a heart valve condition marked by the displacement of an abnormally thickened mitral valve leaflet into the left atrium during systole. ... Mitral stenosis is a narrowing of the orifice of the mitral valve of the heart. ... Aortic valve stenosis (AS) is a heart condition caused by the incomplete opening of the aortic valve. ... Aortic insufficiency (AI), also known as aortic regurgitation (AR), is the leaking of the aortic valve of the heart that causes blood to flow in the reverse direction during ventricular diastole, from the aorta into the left ventricle. ... Pulmonary valve stenosis is a medical condition in which outflow of blood from the right ventricle of the heart is obstructed at the level of the pulmonic valve. ... Myocardium is the muscular tissue of the heart. ... In medicine (cardiology), myocarditis is inflammation of the myocardium, the muscular part of the heart. ... Dilated cardiomyopathy or DCM (also known as congestive cardiomyopathy), is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is dilated, often without any obvious cause. ... Hypertrophic cardiomyopathy, or HCM, is a disease of the myocardium (the muscle of the heart) in which a portion of the myocardium is hypertrophied (thickened) without any obvious cause. ... Restrictive cardiomyopathy (RCM) is the least common cardiomyopathy. ... Arrhythmogenic right ventricular dysplasia (ARVD, also known as arrhythmogenic right ventricular cardiomyopathy or ARVC) is a type of nonischemic cardiomyopathy that involves primarily the right ventricle. ... The normal electrical conduction in the heart allows the impulse that is generated by the sinoatrial node (SA node) of the heart to be propagated to (and stimulate) the myocardium (Cardiac muscle). ... First degree AV block or PR prolongation is a disease of the electrical conduction system of the heart in which the PR interval is lengthened. ... Second degree AV block is a disease of the electrical conduction system of the heart. ... Third degree AV block, also known as complete heart block, is a defect of the electrical system of the heart, in which the impulse generated in the atria (typically the SA node on top of the right atrium) does not propagate to the ventricles. ... Bundle branch block refers to a disorder of the hearts electrical conducting system. ... ECG characteristics of a typical LBBB showing wide QRS complexes with abnormal morphology in leads V1 and V6. ... Right bundle branch block (RBBB) is a cardiac conduction abnormality seen on electrocardiogram (EKG). ... Bifascicular block is a conduction abnormality in the heart where two of the three main fascicles of the His/Purkinje system are blocked. ... Trifascicular heart block is the triad of first degree heart block, right bundle branch block, and either left anterior or left posterior hemi block seen on an electrocardiogram (EKG). ... Wolff-Parkinson-White syndrome (WPW) is a syndrome of pre-excitation of the ventricles of the heart due to an accessory pathway known as the Bundle of Kent. ... Lown-Ganong-Levine syndrome (LGL) is a syndrome of pre-excitation of the ventricles due to an accessory pathway providing an abnormal electrical communication from the atria to the ventricles. ... The long QT syndrome (LQTS) is a heart disease in which there is an abnormally long delay between the electrical excitation (or depolarization) and relaxation (repolarization) of the ventricles of the heart. ... Cardiac arrhythmia is a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ... A supraventricular tachycardia (SVT) is a rapid rhythm of the heart in which the origin of the electrical signal is either the atria or the AV node. ... AV nodal reentrant tachycardia (AVNRT) is a type of reentrant tachycardia (fast rhythm) of the heart. ... Ventricular tachycardia (V-tach or VT) is a fast rhythm that originates in one of the ventricles of the heart. ... Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). ... Ventricular fibrillation (V-fib or VF) is a cardiac condition which consists of a lack of coordination of the contraction of the muscle tissue of the large chambers of the heart that eventually leads to the heart stopping altogether. ... pac This page meets Wikipedias criteria for speedy deletion. ... This article does not cite any references or sources. ... Sick sinus syndrome, also called Bradycardia-tachycardia syndrome is a group of abnormal heartbeats (arrhythmias) presumably caused by a malfunction of the sinus node, the hearts natural pacemaker. ... Cardiomegaly is a medical condition wherein the heart is enlarged. ... Although ventricular hypertrophy may occur in either the left or right or both ventricles of the heart , left ventricular hypertrophy (LVH) is more commonly encountered. ... Left ventricular hypertrophy (LVH) is the abnormal thickening of the myocardium (muscle) of the left ventricle of the heart. ... Right ventricular hypertrophy (RVH) is a form of ventricular hypertrophy affecting the right ventricle. ... Section of an artery An artery or arterial is also a class of highway. ... An arteriole is a blood vessel that extends and branchs out from an artery and leads to capillaries. ... The word capillary is used to describe any very narrow tube or channel through which a fluid can pass. ... Renal artery stenosis is the narrowing of the renal artery. ... Aortic dissection is a tear in the wall of the aorta (the largest artery of the body). ... Raynauds phenomenon (RAY-noz), in medicine, is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other extremities, named for French physician Maurice Raynaud (1834 - 1881). ... Raynauds disease (RAY-noz) is a condition that affects blood flow to the extremities which include the fingers, toes, nose and ears when exposed to temperature changes or stress. ... Buergers disease (also known as thromboangiitis obliterans) is an acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet. ... Intermittent claudication is a cramping sensation in the legs that is present during exercise or walking and occurs as a result of decreased oxygen supply. ... In medicine, hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is a genetic disorder that leads to vascular malformations. ... A spider angioma (also known as a nevus araneus, spider nevus, or vascular spider) is a type of angioma found slightly below the skins surface, often containing a central red spot and reddish extensions which radiate outwards like a spiders web. ... In the circulatory system, a vein is a blood vessel that carries blood toward the heart. ... Lymph originates as blood plasma lost from the circulatory system, which leaks out into the surrounding tissues. ... Lymph nodes are components of the lymphatic system. ... Thrombosis is the formation of a clot or thrombus inside a blood vessel, obstructing the flow of blood through the circulatory system. ... Phlebitis is an inflammation of a vein, usually in the legs. ... It has been suggested that this article or section be merged into deep vein thrombosis. ... This article is about Deep-vein thrombosis. ... May-Thurner syndrome is deep vein thrombosis of the iliofemoral vein due to compression of the left common iliac vein by overlying right common iliac artery. ... A venous thrombosis is a blood clot that forms within a vein. ... In medicine (gastroenterology and hepatology), Budd-Chiari syndrome is the clinical picture caused by occlusion of the hepatic vein. ... Renal vein thrombosis (RVT) is the formation of a clot or thrombus obstructing the renal vein, leading to a reduction in drainage of the kidney. ... Paget-Schroetter disease (also Paget-von SchrÃ¶tter disease) refers to deep vein thrombosis of an upper extremity vein, including the axillary vein or subclavian vein. ... Vein gymnastics in the barefoot park Dornstetten, Germany. ... This article or section is in need of attention from an expert on the subject. ... In medicine (gastroenterology), esophageal varices are extreme dilations of sub mucosal veins in the mucosa of the esophagus in diseases featuring portal hypertension, secondary to cirrhosis primarily. ... Cross section showing the pampiniform plexus Varicocele is an abnormal enlargement of the veins in the scrotum draining the testicles. ... Gastric varices are dilated submucosal veins in the stomach. ... Caput medusae means dilated veins around the umbilicus. ... Superior vena cava syndrome (SVCS) is a result of obstruction of the superior vena cava. ... Lymphadenopathy is a term meaning disease of the lymph nodes. ... Azskeptic 17:34, 10 July 2007 (UTC) Lymphedema, also spelled lymphoedema, also known as lymphatic obstruction, is a condition of localized fluid retention caused by a compromised lymphatic system. ...

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