Atrial Flutter

WHAT YOU SHOULD KNOW:

Atrial (Ay-tre-al) flutter is when the atria (top two chambers of your heart) beat faster than normal. With atrial flutter, there is more than one atrial contraction (squeeze) for every heartbeat. Because the atria beat too fast, the ventricles may not be able provide good circulation to the body with every heartbeat. Atrial flutter often happens with another arrhythmia called atrial fibrillation (fib-ri-LAY-shun). Some people with atrial flutter do not have noticeable symptoms. Others feel weak, dizzy, or faint. Some feel pain or fluttering in the chest, or have trouble breathing. Your atrial flutter may come and go, last for only a short time, or be a life-long condition.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

If your atrial flutter is not treated, your body may not get the oxygen it needs to work well. Untreated atrial flutter increases your chance of heart failure, a heart attack, stroke, and fluid or blood clots in the lungs. The sooner you are treated the better your chance of avoiding these problems.

WHILE YOU ARE HERE:

Activity:

• You may need to rest in bed until your heart rhythm is under control. Ask caregivers if you may exercise your legs in bed. Do this by lifting one leg off the bed and drawing big circles with your toes. Then do it with the other leg. Another good exercise is to lie on your side and pretend to pedal a bike. This may make your legs stronger and help circulation. Stop exercising if you become tired.
  
  
• Your caregiver will tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you ever feel weak or dizzy, sit or lie down right away. Then call your caregiver.

Call button: You may use the call button when you need your caregiver. Pain, trouble breathing, or wanting to get out of bed are good reasons to call. The call button should always be close enough for you to reach it.

Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.

Tests: You may need one or more of the following tests. The results of these tests help caregivers plan the best way to treat you.

• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.
  
  
• Echocardiogram:
  
  
  • This test is also called an echo. It is a type of ultrasound, using sound waves to show pictures of the size and shape of your heart. An echo also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen.
    
    
  • This test is done while lying down on your back. Clear jelly will be squirted on your chest to help the ultrasound sensor slide easily. The sensor will be rubbed across your chest to see your heart from different angles. You may hear a whooshing noise, which is the sound of your blood flow. Caregivers may ask you to pedal a bike during the test (exercise echo) or you may get medicine before the test to increase blood flow to your heart muscle (stress echo). This test can tell how well your heart is pumping. An echo can also find problems, such as fluid around the heart or problems with your heart valves.
  
  
• Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.
  
  
• Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating. Men 19 years old and older should drink about 3.0 Liters of liquid each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). Certain foods also contain liquid. You may need more or less liquid each day. Ask your caregiver how much liquid you should have each day. Ask caregivers if they need to measure or collect your urine before you dispose of it.
  
  
• Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• Transesophageal echocardiogram (TEE):
  
  
  • A transesophageal (trans-e-sof-ah-JEE-al) echocardiogram is a type of ultrasound that shows pictures of the size and shape of your heart. It also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen. You may need a TEE if your heart does not show up very well in a regular echocardiogram. You may also need a TEE to check for blood clots in your atria.
    
    
  • You will be given medicine to relax you during a TEE. Caregivers put a tube in your mouth that is moved down into your esophagus (food pipe). The tube has a small ultrasound sensor on the end. Since your esophagus is right next to your heart, your caregiver can see your heart clearly.
  
  
• 12-lead ECG: This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.
  
  
• Urine sample: A sample of your urine is collected and sent to a lab for tests. Your caregiver may give you a special wipe and clean cup. Use the wipe to clean the skin around the opening where you pass urine. Urinate into the clean cup. Put the lid on the cup. Do not touch the inside of the cup or the lid. Give the urine sample to your caregiver.

Medicines:

• Blood pressure medicine: This medicine may be given to lower your blood pressure. Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs.
  
  
• Blood thinners: This medicine helps stop clots from forming in the blood. Clots can cause strokes, heart attacks, and death. Blood thinners may make it easier to bleed or bruise. While taking this medicine, use a soft toothbrush to prevent bleeding gums. If you shave, use an electric shaver.
  
  
• Diuretics: This medicine is often called "water pills". Diuretics help your body get rid of extra fluid (edema) in your legs and ankles. This medicine may also help get rid of extra fluid in your lungs or around your heart. It may also decrease your blood pressure. You may urinate more often when taking diuretics.
  
  
• Heart medicine: This medicine may be given to make your heart beat stronger or more regularly. There are many different kinds of heart medicines. Talk with your caregiver to find out what your medicine is and why you are taking it.

Treatment options: The treatment that is right for you depends on how bad your atrial flutter is. It also depends on how long you have had atrial flutter, what is causing it, and other heart or rhythm problems you may have. There are several ways that your caregiver may try to get your heart into a better rhythm or rate. Your treatment may change if your atrial flutter is not being controlled. This is often decided after you have tests. You may have some of the following treatments alone or together.

• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier. It may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose. Tell your caregiver if your nose gets dry or if the mask or prongs bother you. Ask your caregiver before taking off your oxygen. Never smoke or let anyone else smoke in the same room while your oxygen is on. Doing so may cause a fire.
  
  
• Pressure stockings: These tight elastic stockings help to keep blood from staying in the legs and causing clots. The stockings are also called Ted Hose® or Jobst Stockings®.
  
  
• Cardioversion: This is when an electric shock is given to the heart. The shock is usually given through paddles or sticky patches placed on your chest or back. The shock helps your heart return to a normal beat. Cardioversion (KAHR-dee-oh-ver-zhun) may be needed if medicine does not make your heart work better. You may need a cardioversion if your heart rhythm is making you sick or is dangerous. You may be given medicine to help you relax before getting the electric shock. If the shock works, your heart rate and rhythm will return to normal. Medicine may be needed to keep your heart in a normal rhythm. You may need a cardioversion more than once.
  
  
• Catheter ablation: This is a procedure where a wire is fed through an artery or a vein to your heart. Your doctor finds the area of the heart muscle causing the unorganized impulses. Heat energy is applied to the area to stop the abnormal impulses.
  
  
• Temporary pacemaker:
  
  
  • This is a machine that helps your heart beat at a normal speed and in a regular rhythm. A temporary pacemaker may use large patches placed on your chest and back. These are connected to a special monitor. Sometimes, your caregiver may need to put small wires through your skin and into your heart muscle instead. The wires may then be connected to a small pacemaker box outside of your body.
    
    
  • The temporary pacemaker "reads" what your heart is doing. If your heart is beating in a different way than it should, the pacemaker takes over and controls your heartbeat. It does this by sending small electric signals to the heart muscle. This tells your heart when to beat. You may feel these signals, especially if your temporary pacemaker uses large patches on the skin. If this causes pain, use your call light and tell your caregiver. Do not get out of bed without first asking your caregiver if it is OK. You may need a pacemaker just for a short time. In some cases, you may need it for the rest of your life. Your caregiver may place a permanent pacemaker if it is needed.
  
  
• Permanent pacemaker:
  
  
  • A permanent pacemaker is a small device that helps regulate your heart rate. A permanent pacemaker is about the size of a wristwatch, and is implanted under your skin. You may need a pacemaker to slow your heartbeat down, speed it up, or make it more regular.
    
    
  • A pacemaker is made up of leads (thin flexible wires) and a generator (JEN-e-ray-tor) (battery). Getting a pacemaker involves having a procedure done. Most pacemakers work only when they are needed. These are called demand pacemakers. Other pacemakers work all the time. Your caregiver will decide which pacemaker is right for you.
  
  
• Internal atrial defibrillator (atrial ICD):
  
  
  • An internal cardioverter (CAR-dee-oh-ver-ter) defibrillator (dee-FIB-ri-la-ter) is also called an ICD. It is a small device that monitors your heart rate and rhythm. If your ICD senses that your atria are beating too fast, it will give your heart a small electrical shock. This helps your heart start beating normally again.
    
    
  • An ICD is made up of a generator and leads (thin, flexible wires that attach to your heart). The generator and the leads will be placed inside you during a procedure. The generator has a metal shell with a battery and a small computer inside.
  
  
• Maze surgery: This is a procedure where a surgeon makes many small cuts into the heart muscle. These cuts create a maze-like new path for the heart impulses to travel. This helps your heart beat in a more normal rhythm.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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