Atrial Flutter vs Atrial Tachycardia with AV block - page 2

I am a BSN student currently working as a monitor tech (Also an EMT). Lately I have noticed that many providers (Medics, RNs and even some MDs) just label any rhythm with multiple P waves Atrial... Read More

  1. Visit  ChaseZ profile page
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    What bothers me are the people who do not understand that not all MIs are the same. Like the person who sees ST elevation in leads II, III, aVF and grabs the Nitro because the patient is having a STEMI but fails to realize they are having an inferior MI with right ventricle involvement and destories their pressure. Oops
  2. Visit  Zookeeper3 profile page
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    it does matter as with reentry loops, especially the aflutters, they can be easily fixed with an electophysiology intervention. a flutters are an "easy" one line burn. so heck yeah, i try to identify the specific rhythm because treatment is different if you are looking at options in an area where the ventricular rate is stable as well as hemodynamics.

    atrial flutter is easily cured, i can't imagine a cardiologist not caring either way, seems crazy to me.

    most cardiologists i work with don't call an ep specialist stat, but they will look at reentry loop treatment differently. when the patient is stable, you have this luxury though.
  3. Visit  Zookeeper3 profile page
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    [quote=letschill;6706895]i would have to agree here, for sure. if we are talking about indistinguishable fast rhythms, most cardiologists are not so interested in the strip that they really care exactly what every 6 second strip indicates (because some folks' rhythms change that frequently). they mostly care if the patient is symptomatic (low bp, diaphoretic, chest pain, dizzy) or not.


    have to respectfully disagree here. any doc can treat an unstable patient looking at a six second strip. any acls certified person can as well.

    cardiologists look at the entire 12 lead as well as axis deviation, bundle branch blocks, transition as well as for electrolyte disturbances and hypertrophy in making treatment decisions.

    a stable aflutter is treated very differently than an atrial tach with a block. research aflutter ablations please.

    .
  4. Visit  missnurse01 profile page
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    [quote=zookeeper3;6711229]
    Quote from letschill
    i would have to agree here, for sure. if we are talking about indistinguishable fast rhythms, most cardiologists are not so interested in the strip that they really care exactly what every 6 second strip indicates (because some folks' rhythms change that frequently). they mostly care if the patient is symptomatic (low bp, diaphoretic, chest pain, dizzy) or not.


    have to respectfully disagree here. any doc can treat an unstable patient looking at a six second strip. any acls certified person can as well.

    i think in looking at a stable pt, looking at the strip goes by the wayside for many cardiologists-as to nailing down a specific name for something unusual. it seems that the nurses are often way more anal about assigning name when the rhythm isn't standard, and the docs will chart a general description (atrial rhythm, ventricular rhythm, etc) rather than try to specify. unstable pt, whole different story.

    cardiologists look at the entire 12 lead as well as axis deviation, bundle branch blocks, transition as well as for electrolyte disturbances and hypertrophy in making treatment decisions.

    a stable aflutter is treated very differently than an atrial tach with a block. research aflutter ablations please.

    .
    it so depends on your pt population and possible underlying etiologies for aflutter. i have very rarely seen pt's go to ep lab (i have worked for 15 years and across the u.s.) for any kind of ablation. mostly it seems that the cards docs feel it wouldn't help (pt would quickly deteriorate back to their faulty rhythm). many cvicu pt's have post op atrial arrhythmias that are treated pharmacologically, or just expected to be in that rhythm short or long term. i feel that it so depends on your location across the country as well as md preference and pt population. no absolutes.
  5. Visit  Pheebz777 profile page
    0
    Do I distinguish between a tachycardic A-flutter and A-tachycardia with and AV block? - yes. On the monitor A-flutter is not always going to look like your textbook A-flutter. If you work as a monitor tech, you'll experience various degrees of every rythm you'll encounter. Is it important to distinguish between the 2? - only if the patient exhibits signs of hypoperfusion and is symptomatic. Treating the cause of the tachycardia is more important than knowing which of the 2 rythms the patient exhibits. Febrile? Pain? dehydration? Treat those first and if the patient is stable, there's no need to further any treatment based on those rythms alone as well as the patients clinical status.

    I guess your question is "why don't people know their rythms?" I presume? Probably coz they don't take the time to read them. In the case of the MD's mis-labeling rythms, they have their reasons.
    Last edit by Pheebz777 on Jul 22, '12
  6. Visit  sooperdooper profile page
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    Quote from ChaseZ
    I am talking more about rhythms with a cotrolled ventricular rate as apposed to indistinguishable SVT rhythms. As far as people calling anything with multiple p waves A Flutter, I think if is just a lack of understanding of the patho involved in various rhythms (ie A flutter being a reentry loop in the atria vs accelerated firing of the SA node in A tach) . Not that they should know, to most people it really is not a concern as they just focus on identifying the basic rhythms and recognizing potentially fatal arrhythmias. I am not trying to knock on ER nurses but it seems I get these mix ups a lot. The other day I had an ER nurse report that a patient was " A flutter in the 40's"......turned out to be some beautiful 2nd degree type II. Here is an example. When in ER the rhythm had a 1:1 P:QRS but with a varying PRI, they called it Sinus Rythm. Once on our cardiac floor, the nurse noticed the 2:1 block and called it A Flutter. I personally charted it as Atrial tach with a variable AV block (Looks almost like an underlying Wenckeback). Not saying I am correct, just my interpretation, I am still fairly new. http://i204.photobucket.com/albums/b...8/a176fbd0.jpg Letschill, good point on the dig toxicity, I also think it is common in patients wil valvular disease.
    That doesn't look like atrial tach to me. The p to p interval is the same. I actually put calipers up to my screen and mapped it out. Sometimes its buried in the T wave, but its there. This is just Atrial Flutter.
  7. Visit  IHeartDukeCTICU profile page
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    I tend to agree with the OP interpretation, leaning more towards a block. I've seen patients with 3rd deg heart block with atrial and ventricular rates within 20 bpm of each other. Tends to make it look almost regular sinus minus some missed QRS and what appears to be irregularity. Looking at that strip, to me, it looks more like 2nd deg type I... lengthening PRS then eventually a PRS w/o a QRS. If the P intervals truly march out, maybe a 3rd deg block with atrial and ventricular rates close to each other. Doesn't look like typical A-flutter to me though.
  8. Visit  Esme12 profile page
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    Quote from ChaseZ
    What bothers me are the people who do not understand that not all MEn are the same. Like the person who sees ST elevation in leads II, III, aVF and grabs the Nitro because the patient is having a STEMI but fails to realize they are having an inferior MI with right ventricle involvement and destroys their pressure. Oops
    Not all inferiors are true posterior wall MI's.

    The EKG strip? I don't believe that is flutter. There is no "saw tooth" configuration of the atrial activity and the atrial rate is not > 250. The atria and ventricles are beating independent of each other and doing their own thing.....it's AV disassociation, 3rd degree.

    Now if cardiology wants to call it A.Flutter to not address that this is really heart block....ok by me.
  9. Visit  IHeartDukeCTICU profile page
    1
    Quote from Esme12

    Now if cardiology wants to call it A.Flutter to not address that this is really heart block....ok by me.
    Haha! So true.

    Yeah after looking at it with my fiance (CCU RN), we figured looks more like 3rd degree rather than 2nd... p waves march out, AV dissociation.
    Esme12 likes this.
  10. Visit  sooperdooper profile page
    0
    Quote from IHeartDukeCTICU
    If the P intervals truly march out, maybe a 3rd deg block with atrial and ventricular rates close to each other. Doesn't look like typical A-flutter to me though.
    I'd agree with that. I initially felt it was this however, A flutter doesn't always present in the typical saw tooth fashion. In any cases, sometimes hard to deciper some rhythms due to rates.
  11. Visit  8jimi8ICURN profile page
    0
    looks like 3rd degree.

    All the conjecture about who misses or mislabels what is just ego-stroking nonsense. Watch your patients, watch your strips and watch your drips.

    Being busy judging other providers will cause you to miss something.

    Then who loses?

    Your patient.
  12. Visit  LetsChill profile page
    0
    Quote from 8jimi8ICURN
    looks like 3rd degree.

    All the conjecture about who misses or mislabels what is just ego-stroking nonsense. Watch your patients, watch your strips and watch your drips.

    Being busy judging other providers will cause you to miss something.

    Then who loses?

    Your patient.
    Exactly. I'll applaud that response.
  13. Visit  kissafish4 profile page
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    Yeah the only blocks atropine is usually used for is mobitz 1 or complete heart block. Wouldn't work for Second degree type 2. Chase I worked as a monitor tech for 12 years before going to nursing school and it really frustrated me when the nurses couldn't accurately interpret their own rhythms. Often I would receive patients from the ER with heart rates in the teens and low 20s where the nurse has reported "sinus brady" when they're clearly in a complete block. Everyone has their specialty and although every patient has a heart, not every nurse is a cardiac one.


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