[al7139]

To the folks discussing rate of A-Flutter:
I was taught that the ATRIAL Rate is high (200-400). Is this what you mean when you say rate? I was also taught that the ventricular rate is usually 1/2 to 1/3 the atrial rate, depending on AV conduction ratio. So the rate that is measured on telemetry is the Ventricular rate and is most often 100 or less. Is this correct?
Amy

[TachyBrady]

Originally Posted by al7139

To the folks discussing rate of A-Flutter:
I was taught that the ATRIAL Rate is high (200-400). Is this what you mean when you say rate? I was also taught that the ventricular rate is usually 1/2 to 1/3 the atrial rate, depending on AV conduction ratio. So the rate that is measured on telemetry is the Ventricular rate and is most often 100 or less. Is this correct?
Amy

The majority of flutter rhythms I've seen have been controlled (ventricular rate less than 100). However, there is the occasional rhythm that Dinith mentioned that appears to be a sinus tach but in reality is a 2:1 flutter. The T wave is really a second P wave or the P wave is buried in the T wave. The ventricular rate is around 150.

If you have what looks like 2 P waves for every QRS, i.e. 2:1 conduction, and a ventricular rate of less than 100, you know that it cannot be an atrial flutter because the atrial rate in atrial flutter HAS to be 280 to 320 (some sources vary on the actual range but you are safe to say an average rate of 300 beats per minute). If the ventricular rate is 80 and there are 2 P waves for every QRS, you would times 80 by 2 to equal an atrial rate of 160. This cannot be because the atrial rate in flutter is always around 300.

This is a complicated concept but it can be helpful in rhythm determination.

[Spidey's mom]

Big sigh . . . . this is why I hate cardiac rhythm stuff . . . . people disagree about what should, imo, be fairly black and white.

You should see the different answers I get when I ask folks to interpret a strip.

I do appreciate that people are trying to help out the op . .. . . not whining about that . . . . it is just very frustrating for me personally.

(Can you tell I'm going to take a test on cardiac rhythms today?).

sirI - the emedicine links you provided don't show the strips very well and you have to be a paid member to see it enlarged. The definitions show though:

Atrial fibrillation. Ventricular rate varies from 130-168 beats per minute. Rhythm is irregularly irregular. P waves are not discernible.

Atrial flutter has traditionally been characterized as a macroreentrant arrhythmia with atrial rates between 240-400 beats per minute

Oh, and the ECGSim is so tiny, I can't read the definitions. . . looks like I have to buy the actual product. I can see the ecg's though . . . .

[NurseCherlove]

Originally Posted by Nightcrawler

I am not trying to be contrary either, but I respectfully disagree. I have seen a-flutter with a ventricular rate of 30 in a patient who was post inferior MI, so a-flutter is not necessarily a tachy anything.

With a ventricular rate of 150 it is very difficult to tell WHAT rate the patient is actually in, and could be interpreted as anything from SVT to VT.

"With typical atrial flutter, atrioventricular (AV) conduction usually is 2:1, making the ventricular rate approximately 150 beats per minute (bpm)." (From E-medicine).

I suppose I was thinking of TYPICAL a flutter.

Also, it's hard to imagine a flutter being possibly interpreted as v tach. But then again, my actual cardio experience is limited at this point. Well, ok, perhaps polymorphic v tach - I could see that.