A 43 Year Old Hospitalized Man Complains Of Sudden Episodes Of Dizziness and Lightheadedness

A 43 year old man who is hospitalized with Symptoms of heart failure complains of sudden episodes of dizziness and lightheadedness, he was otherwise fine and was responding to the treatment for heart failure. An ECG was done and shows the following appearance:

What is the diagnosis on the basis of characteristic appearance on the ECG.
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Atrial Flutter ( Saw tooth waves on ECG )

Case Discussion:
Atrial Flutter is an abnormal heart rhythm and is one of the types of supraventricular tachycardia. It is similar to atrial fibrillation and sometimes both may occur one after the other.

Risk Factors: Certain underlying medical conditions increase the risk of developing atrial flutter, theses may include:

• Heart failure
• Previous heart attack
• Valvular abnormalities
• High blood pressure
• Recent surgery
• Thyroid disorders
• Diabetes
• Alcoholism 
• Chronic lung disease

Clinical Features: In most cases the patients are asymptomatic, but there may complain of:

• Palpitations
• Shortness of breath
• Faintness, dizziness or light headedness
• Intolerance to exercise
• Chest pain

Management:

Atrial flutter itself is not life threatening but sometimes if left untreated it may lead to complications of embolus and stroke. It may progress into atrial fibrillation or other heart arrhythmias. 

Some anticoagualtion treatment is required to prevent thrombus formation.

Drugs that control the heart rate and rhythm are useful.

Sometimes electrical cardioversion may be needed but atrial flutter usually requires low energy shock to return to sinus rhythm