Atrial flutter (AFL) | Circulatory System and Disease | NCLEX-RN | Khan Academy

Created by Bianca Yoo.
Watch the next lesson: www.khanacadem...
Missed the previous lesson? www.khanacadem...
NCLEX-RN on Khan Academy: A collection of questions from content covered on the NCLEX-RN. These questions are available under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 United States License (available at creativecommons....
About Khan Academy: Khan Academy offers practice exercises, instructional videos, and a personalized learning dashboard that empower learners to study at their own pace in and outside of the classroom. We tackle math, science, computer programming, history, art history, economics, and more. Our math missions guide learners from kindergarten to calculus using state-of-the-art, adaptive technology that identifies strengths and learning gaps. We've also partnered with institutions like NASA, The Museum of Modern Art, The California Academy of Sciences, and MIT to offer specialized content.
For free. For everyone. Forever. #YouCanLearnAnything
Subscribe to Khan Academy’s NCLEX-RN channel: / @khanacademynclex-rn7898
Subscribe to Khan Academy: www.youtube.co...

[@StrongMed]

This series overall is great, but @0:47, don't conflate automaticity and reentry. Atrial flutter is caused by reentry, which is a completely separate pathophysiologic mechanism as abnormal automaticity. (i.e. there isn't a discrete "irritable focus" in a-flutter).

[@MrDanshe]

Eric's Medical Lectures Yes, exactly! But could You, please, explain the mechanism? Like, how does flutter occur through re-entry pathway? As far as I understood, it all starts with premature electrical impulse and then what?

[@tiagoicbas]

+Daniil Shevchenko I was here to try to understand atrial flutter, so I am not the best person to explain it to you. But the idea I got from reading my textbooks is that you don't need a premature electric impulse. In fact there are several ways in which atrial flutter may develop - the most common is by the isthmus-dependent clockwise atrial flutter (I'm transcribing it from the Current Cardiology's Textbook). What I got from reading was that the electric impulse travels from the SA node to the right side of the right auricle, then downwards to the tissue near the auriculoventricular septum. There you have an "anatomically fixed circuit" that allows the impulse to travel along the floor of the right atrium between the tricuspid valve annulus and the inferior vena cava, then it goes up the interatrial septum, acrros the roof and down the free wall of the right atrium once again (this last description is transcribed from another textbook - I don't have the frontpage :/ sorry!). My problem is here is that I can't understand how does this mechanism produces the odd shape of the F waves - is it that the reentry happens in a refractory period of the atrial tissue, so the signal does not travel so efficiently?

[@cri0871]

You need an extrasystole for the flutter to happen. And this extrasystole is conducted through a reentry circuit. The odd form of the F waves is probably caused by the fact that the circuit is a Macro-circuit not a micro circuit (like it is in atrial fibrilation where we have f waves). It's correct what she says in the video according to my textbook

[@jhanvish]

According to my textbook it is the reentrant circuit in the right atrium which causes atrial flutter and not automaticity which is associated with extrasystole or premature ectopic beats.

[@jakubhonek9400]

Nicely explained, however, there are two mistakes - atrial flutter is not a focal arthythmia - it is a reentry arrhythmia and also the conduction in the example is not 3:1, but rather 4:1 - there is always one flutter wave (wether you call it a f wave or p wave) hidden in the QRS comlex.

[@ahmedshams8807]

+Jakub Honek Can you explain more ?

[@jakubhonek9400]

+Ahmed Shams Under normal circumstances the electrical impulse starts in the SA node (the physiological pacemaker). In so called focal arrhythmias another focus (a localized small part of the atrial muscle tissue) takes over the rythm. Lets say you are just resting and your heart rate is 60 beats per minute - this is the rate of the SA node. If the ectopic focus starts firing at a speed of for example 180/min it will set a new faster pace (the SA node will be discharged with every of the 180 betas and therefore will not have a chance to fire). In contrast atrial flutter is a reentrant arrhythmia. There is no localized focus firing, instead the electric impulse strats circling perpetualy in the atrium (in typical atrial flutter it is in the right atrium around the tricuspid valve). For a reentry circuit to take place there has to be an area of slow conduction. Under normal circumstances the whole muscle mass of the atria (and then also the ventricles) is depolarized (or discharged) in a all or none fashion - taht meas the electricity goes through the whole atria and doesnt leave a single cell behind. If there is an area of slow conduction the elctric signal eneters it from one side, meanwhile the whole electric process in te atria is terminated and the muscle behind the area of slow conduction is ready to be depolarized again, so when the electricity leaves it it starts circulating the atrium (around some obstacle - in typical flutter it is the tricuspid valve) to reach the beginning point taht is by now ready again...here starts the circuit that repeats over and over again. I hope this helped.

[@gilgithunzatravelbydrfatim7544]

@@jakubhonek9400 yup great way of explanation thank u jazakAllah

[@doctorboy5892]

Whether it is a fast atrial focus, a circuit, or a little man in the atria pinching the endocardium, we treat it the same. Slow the ventricles with a beta blocker or calcium channel blocker, check for a thrombus in the atria with an echo, then synchronous cardioversion with 50 Joules.

[@MohammadrezaSd4574]

Thank you, So useful👌

[@joshaa9361]

Gratitude

[@nogardmarith]

I was recently hospitalized for this problem XD

[@anandrahangdale5214]

Can you send me your ECG ? [e-mail]

[@123weeezy]

In lecture today we learned that atrial flutter waves are not P waves because they do not originate from the SA node, but from a reentry circuit present in the atria. Could you clarify this?

[@Jualgumo]

Sooo.. If it is not from the atria it is not a P-wave right? What about wandering atrial pacemaker? Or High Junctional Escape? Or Sinus rhythm with a premature atrial complex? All of them are P-waves. Just because it is not from the SA node it doesn’t mean that it is not a P-wave. Also, don’t confuse P-waves with incomplete atrial signals. I.e A.Fib and A.Flutter. A.Fib does not have P-waves because there are multiple signals overlapping and interrupting each other (Fibrillation Waves) and A.Flutter is not a cell firing, it is caused by a lesion in the atria which causes reentry

[@caroleewalker5546]

❤ Thank you for this information.

[@you4us]

nice, excellent and strait to the point, thnx

[@bigshash9946]

Excellent. Thank you.

[@sarah5578]

thank you!

[@1412Z]

Thank youuu

[@vaniasegura8360]

Thank you thank you thank you!!!!

[@anivaanuthqi4908]

thanks for making this

[@mitchellmbah6741]

In this graph how do you differentiate P waves from T waves? 😢

[@ahmedshams8807]

Superb !

[@LolaLobet]

Thanks sooooo much!

[@fariskhaled5488]

😍😍😍😍😍 great

[@luischavez7870]

Other tissues have this too... I see what you did there.

[@drasadkhan129]

nice

[@swagnikdas524]

Doesn't atrial muscle has refractory period?

[@goldtigrera]

whats the difference between atrial flutter and heart Mobitz block in ECG?

[@doctorboy5892]

In the Mobitz blocks the AV node is shit. Usually from ischaemia secondary to eating McDonalds. The impulses from the atria are conducted down the shit AV node more slowly, prolonging the PR interval and some impulses don't get through the AV node at all.

[@itsbridget6541]

I want to make a vid. Can someone tell me how? I'm just a preteen

[@OJC6]

There are also Atrial Flutters with variable rates of conduction. While most AFlutters are regular some are irregular or only regular some of the time. Also, AFlutter tends to have a fast ventricular rate but, again, this is not always the case. I'm currently monitoring a patient whose rhythm is AFlutter with a variable rate conduction that is also bradycardic in the mid 40's.

[@thecow4555]

It would be nice if she would talk slower. I missed the whole first half.

[@BlehIsaSkateboard]

Ectopische pacemakers

[@mrzero8428]

1:33 Big mistake .. The ventricle still 70~80 Bpm .. Cause The AV Node is still working !

[@Mohtellawi]

There's no mistake, there are many type of flutter, 150 bpm is in the case of 2 to 1 conduction. 3:1 100 bpm 4:1 75 bpm