Atrial Flutter in a 70-Year-Old Male

Atrial Flutter in a 70-Year-Old Male

Atrial Flutter with 2:1 AV Conduction

🏥 Clinical Context

A 70-year-old male presents to the emergency department with palpitations and mild shortness of breath. Onset began 3 hours ago while resting. No chest pain or syncope. History of hypertension and prior episode of atrial fibrillation.

🔍 Interpretation Steps

✅ Flutter waves present:

  • There are regular, rapid “sawtooth” flutter waves in the inferior leads (especially leads II, III, aVF).

  • Classic hallmark of atrial flutter.

✅ Atrial rate ≈ 300 bpm:

  • Flutter wave frequency is consistent with typical atrial flutter.

✅ Ventricular rate ≈ 150 bpm:

  • The R-R intervals are regular and spaced at about 300/150 bpm.

  • This strongly suggests 2:1 AV conduction.

✅ QRS complexes are narrow:

  • Confirms that conduction is supraventricular.

📊 Final Diagnosis

Atrial Flutter with 2:1 AV Conduction

⚡ Key ECG Features

  • ECG
  • Irregular rhythm
  • supraventricular tachycardia

🎓 Teaching Pearl

Flutter waves may mimic P waves — always suspect atrial flutter when the ventricular rate is 150 bpm.

🎥 Video Explanation

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