00:01
Take a look at
this beating heart.
00:03
I love the visuals that
were created for you.
00:07
Because anytime you see a
moving picture like this,
again, stop and orient yourself.
00:12
I want you to compare the difference
between the electrical signal
from the top of the
heart, the atrium
to the bottom of the
heart, the ventricles.
00:20
Look how in the ventricles,
you see it shooting down and around,
down and around, down and around,
look at the atrial,
it's just going in a circle.
00:31
So instead of a normal path,
the electrical impulse in atrial flutter,
there's that circular electrical
pathway you see in the atrium.
00:41
So the electrical impulse just moves
really quickly around the atrium.
00:44
It can go between 240 and 340
atrial contractions per minute.
00:51
Stop and think about
how fast that is.
00:54
Now it makes sense why a
patient has a difficult time
pumping enough blood
through the rest of the body
when that atrium is
moving so quickly.
01:03
Because the rapid atrial
contractions prevent the chambers
from filling completely
between beats.
01:09
Now it's one thing
to hear me say that,
but I want you to take
the time to picture it.
01:15
I need the atrium in
a sinus rhythm to be
atrium-ventricle,
atrium-ventricle.
01:21
Remember, we've talked about
it goes SA node, AV node,
you have that
little bit of delay,
and then the ventricles respond.
01:29
That's because we need the atrium to
have time to squish all the blood out,
relax and fill, squish all the blood
out, relax and fill.
01:39
In atrial flutter,
they don't have time for that.
01:43
And that's why atrial
flutter can be problematic
for how your patient even feels.
01:48
So who do you think
is at risk for this?
Well, if a patient has
had prior cardiac surgery,
they're at a risk
for atrial flutter.
01:57
Also, if they've had an ablation
before for atrial fibrillation.
02:01
So the patient may have had atrial
fibrillation, they did a catheter ablation,
that means they went in and
deadened some of the tissue.
02:08
They had that treatment
for atrial fibrillation,
but later on,
they can develop atrial flutter.
02:13
Now, atrial flutter has a
pretty cool look, doesn't it?
I know it seems kind of weird.
02:18
But every time I see this, I'm
like, "Whoa, that is beautiful."
When I'm at clinicals,
I always run strips of this
because look at the
difference in these waves.
02:27
We call them sawtooth waves.
02:30
But let's not get
ahead of ourselves.
02:32
Let's start at the beginning
like we do everything else.
02:35
So heart rate here is
greater than 100 bpm.
02:39
The rhythm is going to be the
R-R, right remember?
Q, R, S, so the R-R is
probably going to be regular.
02:50
But the P waves?
That's what we call
a sawtooth wave.
02:55
Now my dad was a carpenter.
02:57
If you've ever seen the edge
of a blade of a saw blade,
it has those big cuts.
03:04
That's why we call
those sawtooth waves.
03:07
So they're sawtooth
in appearance,
that's very different than
what we saw in atrial fib,
which was just a bunch of trash.
03:14
PR interval,
you can't measure it on this,
and your QRS should be normal.
03:19
Okay, so this is how atrial fib,
it looks much more
organized than atrial fib,
if you're looking at
where the P waves are,
but they definitely look
different than a regular P wave.
03:32
Now, this may be a part of the
heart you're not familiar with.
03:35
But what is the left
atrial appendage?
Let's call the LAA
from here on out,
so you know what
we're talking about.
03:43
But look at this
picture, orient yourself.
03:45
Hey, anytime you see a picture,
I would encourage you if it
involves anatomy and physio,
pause the video and really orient yourself
so you know what you're looking at.
03:56
So you see where the aorta is,
you see where the atrium are,
you see where the ventricles are,
you see the valves in the heart.
04:06
So what is this weird looking
thing coming off the left atrium?
Well, let's take a look at it.
04:14
But before we do,
look at what's
hanging out in there.
04:18
Because that's a site
of clot formation,
that's a risk for a patient, that's the
most likely spot that a clot could form.
04:27
Because this left atrial appendage,
or the LLA is this small,
little weirdly ear-shaped sack of muscle
in the wall that is in the atrium.
04:37
So we're not really sure
what its function is,
but we do know it's really good at
collecting blood and creating clots,
which are extremely
problematic for your patient.
04:49
So why does someone
with atrial fib
or atrial flutter have an
increased risk of clots?
Let's go over and
review that again.
04:58
Well, number one, atrial fib or
flutter causes blood to pool,
and that little ear like
appendage we call the LAA.
05:06
Now when that blood clot forms
it can dislodge from there.
05:09
Now it's going to travel
through the arterial system,
that is a big problem.
05:15
If the blood clot lodges itself
in blood vessels of the brain,
it's going to stop perfusing that
area of the brain and cause a stroke.
05:23
So why do we care that atrial
fibrillation or atrial flutter
causes an increased
risk of clots?
Because it can cause an
increased risk of tissue damage.
05:35
If the clot lodges in the
brain, it can be a stroke.
05:38
If it lodges anywhere
else in the body,
the tissue beneath that
would normally be perfused,
it's going to block the blood flow to that
and you're going to have tissue death.
05:48
So we watch this very
closely in patients
and we treat them for their
increased risk of clots.
05:55
Now, let's look at the
risks of atrial fib.
05:57
And I want you to think
about two major categories.
06:01
So stroke and
cardiac dysfunction,
do you have those down?
Let's talk about stroke first.
06:08
Patients with atrial fib have a five
times greater risk of having a stroke
than a patient without atrial
fib, that matters.
06:17
So we want to be very careful in patients
that have a history of atrial fib,
or have newly developed atrial
fib that we are treating them
to minimize the
risks of a stroke.
06:28
In fact, 15 to 20% of all
strokes are caused by atrial fib.
06:33
And there's also a
link to dementia.
06:36
So, atrial fib, you want to be
thinking the risk of stroke,
and they have a higher risk of stroke and
many strokes are caused by atrial fib.
06:44
And that is due to those
little clots developing
and getting shot through up
to the profusion of the brain.
06:52
Now cardiac dysfunction.
06:54
You lose roughly about 20% of your
cardiac output if you're in atrial fib,
so your cardiac
output is decreased.
07:03
Now eventually this could
even lead to heart failure,
but you'd want to keep an eye on this
patient's overall cardiac function.