ATRIAL FLUTTER

In atrial flutter, the atria of the heart begin to beat in a rapid rhythm because of too many abnormal electrical impulses. The atria may beat up to 300 times per minute. About one half to one fourth of these impulses are passed down to the ventricles. Most of the time this phenomenon is not felt; sometimes there is a feeling of a rapid heartbeat (palpitations). A number of illnesses can cause atrial flutter. Heart or lung disease, thyroid disease, or heart valve disorders are predisposing factors for atrial flutter.

When the atrium is fluttering it is attempting to contract, but the contractions are too fast. The ventricles contract when signaled and beat fast. This abnormal rhythm of the heart is an arrhythmia. This rhythm is considered unstable but may revert to normal spontaneously, or it may convert to atrial fibrillation (a more irregular atrial arrhythmia). Because the ventricles are not filling with blood normally, they must work harder to supply blood to the body. This may eventually cause angina (heart pain caused by a reduction in blood supply to the heart muscle) or heart failure (decreased pumping efficiency of the heart). Symptoms of heart failure are difficulty breathing, chest pain, or fainting.

Atrial flutter is diagnosed by a particular pattern on an electrocardiogram (ECG). The motion of the atrium may be evaluated with an echocardiogram, which is an ultrasound examination of the heart. This examination also can show whether there are blood clots in the atrium.

Therapy for atrial flutter focuses on the cause of the arrhythmia. While the cause is being sought or treated, acute management of the flutter depends on the symptoms and the suspected cause. Heart disease, for example, should be managed, but the flutter may not revert to normal. The flutter can be treated with digitalis (digoxin) to help control the rate at which the ventricles contract. Digitalis also helps make the contractions more efficient. Digoxin therapy often is begun in the hospital so that the level of drug in the blood stream and changes in heart rhythm can be monitored. If digoxin therapy continues outside the hospital, the level of the medicine in the blood has to be checked from time to time.

If clots have formed in the atrium, administration of anticoagulants such as warfarin (e.g., Coumadin) may be started. This medicine can cause easy bruising or bleeding, and levels have to be checked periodically. Sometimes the abnormal rhythm of the heart caused by atrial flutter is electrically shocked to normal. This procedure is called cardioversion.

Medicines to manage thyroid, heart, or lung disease are taken as directed to avoid prolonged atrial flutter or fibrillation. Other prescribed medications should be taken regularly, and levels should be monitored on schedule.

• Stop smoking.
• Reduce your intake of alcohol and caffeine.
• Eat a diet for that is healthful for your heart. Decrease fat and cholesterol intake.
• Lose weight if you are overweight.
• Reduce stress in your life as much as possible, because stress may worsen your symptoms.
• Exercise to your level of tolerance if you are taking the proper medications and have no symptoms.

• Avoid activities that cause bruising if you are taking anticoagulants.
• Do not forget to take your usual medications.

• If you have side effects from your medications or if you have new or worsening symptoms. These include chest pain, shortness of breath or difficulty breathing, fainting, palpitations, or sudden changes in the ability to speak, eat, walk, or use your limbs.
• If you are taking anticoagulants and sustain a serious cut or head injury.

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