Atrial Flutter and Atrial Tachysystole

Atrial Flutter and Atrial TachysystoleATRIAL 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.

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Editor-in-chief of the Medical Actu website; general practitioner graduated from the Faculty of Medicine of Algiers in 2005 currently practicing as a liberal.

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