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Subject: Re: Atrial Flutter
Forum: The Heart Forum
Topic Area: Arrhythmia
Posted by CCF CARDIO MD - CRC on February 03, 1999 at 14:40:33:
In Reply to: Atrial Flutter posted by Vesna on February 02, 1999 at 16:41:46:
Hello,You last answered a question for me on Jan. 19 and I thank you very much. Here is my follow up question:
My mother was diagnosed with atrial flutter. Her heart beat has been between 130-140 beats per minute for about the last 4 months.
Before that, she was diagnosed with atrial fibrulation (her heart beat fast, but irregularly and not for more than several hours at a time). What is the difference between atrial flutter, atrial fibrulation and tachycardia in symptoms, treatment and prognosis.
Also, my mother has somewhat elevated blood pressure and is being treated for that. Her thyroid function is normal and she is otherwise in
very good health. Can you please tell me what tests you would perform to diagnose the cause of the atrial flutter. So far, my mother has had an EKG
and is scheduled for a echo cardiogram. Nothing unusual showed up on the EKG. Thanks --------------------------------------------------------------------------------------------------------------------
Dear Vesna, Atrial flutter is similar to atrial fibrillation in that it is a fast rhythm of the upper chambers (atria) of the heart. Flutter is a more organized rhythm that can be treated with drugs or electrical ablation. Fibrillation is less organized and can only be treated with medications currently.
Below is some more information about afib and questions from other patients. Q: What could possibly cause atrial fib to occur in the first place ?
A: There are many causes of atrial fibrillation. The most common causes are hypertension (high blood pressure) and underlying heart problems (valve problems and coronary artery blockages). Many other less common things also cause afib such as overactive thyroid, infection, alcohol and other illnesses. In some cases no underlying cause can be determined and the term "lone afib" is used. Q: Is it possible for someone who has had atrial fib, found no control with medication, after 5 years to experience a reversal and go back into normal sinus rhythm ?
A: Yes, afib is a chronic condition with waxing and waning of the rhythm. Some people are mostly in sinus rhythm and others mostly in sinus rhythm with others somewhere inbetween.
Q: Would you recommend that i see an electrophysiologist to see if there is anything else that could be done, any other medications or treatment, if the atrial fib resumes again as the predominant rhythm ?
A: An electrophysiologist is a cardiologist who specializes in rhythm disturbances. If you have a particularly challenging case your cardiologist can recommend you to a good electrophysiologist.
Here is some general information concerning afib. Atrial fibrillation
Definition:
A disorder of heart rate and rhythm in which the upper heart chambers (atria) are stimulated to contract in a very rapid and/or disorganized manner; this usually also affects contraction of the ventricles. Causes, incidence, and risk factors:
Arrhythmias are caused by a disruption of the normal functioning of the electrical conduction system of the heart. Normally, the atria and ventricles contract in a coordinated manner. In atrial fibrillation and flutter, the atria are stimulated to contract very quickly. This results in ineffective and uncoordinated contraction of the atria. The impulses may be transmitted to the ventricles in an irregular fashion, or only some of the impulses may be transmitted. This causes the ventricles to beat more rapidly than normal, resulting in a rapid or irregular pulse. The ventricles may fail to pump enough blood to meet the needs of the body. Causes of atrial fibrillation and flutter include dysfunction of the sinus node (the "natural pacemaker" of the heart) and a number of heart and lung disorders including coronary artery disease, rheumatic heart disease, mitral valve disorders, pericarditis, and others. Hyperthyroidism, hypertension, and other diseases can cause arrhythmias, as can recent heavy alcohol use (binge drinking). Some cases have no identifiable cause. Atrial flutter is most often associated with a heart attack (myocardial infarction) or surgery on the heart. Atrial fibrillation or flutter affects about 5 out of 1000 people. It can affect either sex. Atrial fibrillation is very common in the elderly, but it can occur in persons of any age. Prevention:
Follow the health care provider's recommendations for the treatment of underlying disorders. Avoid binge drinking. Symptoms: sensation of feeling heart beat (palpitations)
pulse may feel rapid, racing, pounding, fluttering,
pulse may feel regular or irregular
dizziness, lightheadedness
fainting
confusion
fatigue
shortness of breath
breathing difficulty, lying down
sensation of tightness in the chest Note: Symptoms may begin and/or stop suddenly. Signs and tests:
Listening with a stethoscope (auscultation) of the heart shows a rapid or irregular rhythm. The pulse may feel rapid or irregular. The normal heart rate is 60 to 100, but in atrial fibrillation/flutter
the heart rate may be 100 to 175. Blood pressure may be normal or low. An ECG shows atrial fibrillation or atrial flutter. Continuous ambulatory cardiac monitoring--Holter monitor (24 hour test)-- may be necessary because the condition is often sporadic (sudden beginning and ending of episodes of the arrhythmia). Tests to determine the cause may include: an echocardiogram
a coronary angiography (rarely)
an exercise treadmill ECG
Treatment:
Treatment varies depending on the cause of the atrial fibrillation or flutter. Medication may include digitalis or other medications that slow the heart beat or that slow conduction of the impulse
to the ventricles.
Electrical cardioversion may be required to convert the arrhythmia to normal (sinus) rhythm. Expectations (prognosis):
The disorder is usually controllable with treatment. Atrial fibrillation may become a chronic condition. Atrial flutter is usually a short-term problem. Complications: incomplete emptying of the atria which can reduce the amount of blood the heart can pump
emboli to the brain (stroke) or elsewhere--rare
Calling your health care provider:
Call your health care provider if symptoms indicate atrial
fibrillation or flutter may be present.
The links below are good sources of information about atrial fibrillation. http://www.med-edu.com/patient/arrhythmia/atrial-fib.html
http://www.americanheart.org/Heart_and_Stroke_A_Z_Guide/afib.html
http://www.merck.com/!!vDXoe16kTvDXpz08Of/pubs/mmanual_home/chapt16.htm I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies. Please feel free to write back with additional questions. If you would like to make an appointment at the Cleveland Clinic Heart Center, please call 1-800-CCF-CARE or inquire online by using the Heart Center website at www.ccf.org/heartcenter. The Heart Center website contains a directory of the cardiology staff that can be used to select the physician best suited to address your cardiac problem.
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