History and exam
Key diagnostic factors
common
presence of risk factors
Risk factors include surgical or post-ablation scarring of atria, increasing age, valvular dysfunction, chronic ventricular failure, atrial septal defects, atrial dilation, recent cardiac or thoracic procedures, anti-arrhythmic drugs or digitalis toxicity, heart failure, hyperthyroidism, COPD, asthma, or pneumonia.
worsening heart failure or pulmonary symptoms
These are common underlying conditions, and worsening of symptoms may indicate other decompensation or new-onset atrial flutter. May present as exercise intolerance.
However, presence of acute, severe heart failure suggests haemodynamic instability.[20]
Other diagnostic factors
common
palpitations
Classic symptom, but because atrioventricular block usually results in normal ventricular rate, patients may not have this symptom.
fatigue or lightheadedness
Nonspecific but can be the main presenting symptom.
uncommon
jugular venous pulsations with rapid flutter or cannon waves
Rapid flutter waves can be noted in the jugular venous wave form. Cannon waves (large ‘a’ waves) may also be seen.
chest pain
Can be a symptom of atrial flutter, underlying myocardial ischaemia, or a pulmonary embolic event.
dyspnoea
Can be a symptom of atrial flutter, underlying myocardial ischaemia, or a pulmonary embolic event.
syncope
Rare presentation of atrial flutter.
Suggests haemodynamic instability.[20]
hypotension
Rare presentation of atrial flutter. Atrioventricular block typically results in normal ventricular rate and preservation of blood pressure.
Presence of shock suggests haemodynamic instability.[20]
embolic events
Such as stroke and pulmonary embolism.[5] Rare presentation of atrial flutter.
See our topics Ischaemic stroke and Pulmonary embolism.
myocardial ischaemia
Suggests haemodynamic instability.[20]
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