Overview of Atrial Flutter (Nursing)

by Rhonda Lawes, PhD, RN

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    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.

    About the Lecture

    The lecture Overview of Atrial Flutter (Nursing) by Rhonda Lawes, PhD, RN is from the course Analysis of Abnormal ECG Strips (Nursing).

    Included Quiz Questions

    1. Prior cardiac surgery
    2. Prior catheter ablation
    3. Caffeine
    4. Alcohol
    5. Smoking
    1. 130 beats/min
    2. 90 beats/min
    3. 60 beats/min
    4. 50 beats/min
    1. Stroke
    2. Decreased cardiac output
    3. Heart failure
    4. Increased cardiac output
    5. Kidney failure

    Author of lecture Overview of Atrial Flutter (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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