Which physical findings are characteristic of pediatric atrial flutter?

Updated: Feb 04, 2019
  • Author: M Silvana Horenstein, MD; Chief Editor: Syamasundar Rao Patnana, MD  more...
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Answer

Physical examination in patients with atrial flutter should assess the likely conduction ratio and rate of flutter and assess for signs of associated ventricular dysfunction or heart failure. Depending on the ventricular rate and the individual's tolerance to that rate, symptoms may range from palpitations, dyspnea, presyncope, or syncope to sudden death. If the ventricular response is rapid, atrial flutter may cause significant morbidity secondary to hemodynamic deterioration due to low cardiac output.

If the ventricular response is slow enough to permit a sustained arrhythmia, atrial thrombosis with consequent thromboembolism may result. In patients who have undergone surgery for congenital heart disease, new onset of atrial arrhythmias such as atrial flutter may indicate elevated right atrial pressure and, thus, the need for surgery (eg, conduit obstruction in a patient with a Rastelli-type surgery).

In patients who have undergone the Fontan, Mustard, or Senning operation, the presence of superficial venous collateralization suggests associated obstruction of major venous pathways. This may interfere with evaluation and management.


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