ATRIAL FLUTTER:
CLINICAL SIGNS:
* none.
* or asthenia and moderate dyspnea, palpitations or uncomfortable chest tightness.
* or inaugural lipothymia or even syncope of Adams-Stokes.
* paroxystic tachycardia, by access or permanent, regular at 150 / min (in the mode 2/1) or 100 / min (3/1).
* slowed by the massage of a single carotid sinus for 20 seconds.
* complications: the same as those of atrial fibrillation.
ETIOLOGY:
* valvulopathies : mitral stenosis, aortic insufficiency.
* hypertrophic heart disease.
* dilated heart disease.
* ischemic heart disease.
* hyperthyroidism.
* acute alcoholic intoxication.
* chronic respiratory insufficiency.
iatrogenic: taking digitalis, theophylline.
* hypokalemia, hypo-hypercalcemia.
* idiopathic.
DIAGNOSTIC TESTS:
* scope.
* ECG :
– flutter waves in “factory roof” ( wave F ) at 300 / mn clearly visible in D2D3VFV1, better visible if you do a carotid massage.
– the QRS are fine (unless pre-existing or functional branch block).
Ventricular complexes entrained every 2 or 3 atrial beats.
* holter ECG, echocardiography in a second time.
TREATMENT:
* venous route: G5%, oxygen therapy in the mask.
* drug reduction if recent onset :
– Cordarone :
– Oral loading dose: 30 mg / kg on the first day, 15 mg / kg on the second day, then 1-2 cps / day.
– or 300 mg or 2 ampoules infused 30 minutes then 600-1200 mg / d with the electric syringe
– Reduces better than digitalis, to prefer if underlying functional angor.
– or Digoxin Nativelle : 1 to 2 ampoules a day IV slow (to prefer if left failure).
– or Brevibloc: 0.5 mg / kg IV slow then 0.05 to 0.2 mg / kg / min with the electric syringe, if no contraindication to beta-blockers.
– associated with anticoagulation: Heparin 80 mg / kg IV bolus then relay with the electric syringe (400 to 600 IU / kg / d) or calciparine.
* if failure and if badly tolerated:
– endocavitary stimulation of the right atrium at the frequency of more than 300 or transesophageal.
– external electric shock: 150-200 J under Hypnovel.
– Radiofrequency ablation for rebel or recurrent cases, to be discussed later.
ATRIAL TACHYSYTOLE:
CLINICAL SIGNS:
* idem.
ETIOLOGY:
* idem.
DIAGNOSTIC TESTS:
* ECG :
– regular tachycardia with fine complexes (except if pre-existing or functional branch block) at 130-250 / min with 2-3 / 1 block.
– visible P waves , individualized, with return to the isoelectric line (more P waves than QRS).
TREATMENT:
* idem.
