Other useful tests include a Holter monitor, echocardiogram, and/or an exercise test. The tracing is held in the device’s memory until it can be sent over the phone to a cardiology center. These devices can be used at home or at school to record an ECG at the time of symptoms. If the symptoms don’t occur regularly, this may be done using a small device called a transtelephonic ECG recorder. In order to diagnose atrial flutter, an ECG at the time of symptoms is often needed. If the child is having an episode during the ECG, the heart rate will be fast and there will be many extra "p" waves from rapid atrial contractions. The stickers are connected to a machine that records the heart’s electrical activity. This is a safe and painless test that involves putting some stickers across the chest. Medical tests: One of the first tests usually done is an electrocardiogram. If the child is having an episode at the time of the examination, the pulse rate will be fast. Otherwise, the physical exam is usually normal. Physical findings: If the child has other heart problems, the physical findings that go along with that problem. The episodes can vary both in frequency and duration and may or may or may not be related to exercise. Sometimes the person can have very mild or no symptoms. Symptoms: Symptoms caused by atrial flutter include a feeling of "heart racing" along with dizziness, lightheadedness, low energy levels, chest pain, shortness of breath, and/or fainting. It also rarely occurs during childhood or the teen-age years (except when there are other heart problems as well). Atrial flutter rarely occurs in infants with otherwise normal hearts but when it does it usually resolves within the first year of life. In other people, it occurs often and does not self-convert without medical treatment. In some people, atrial flutter occurs only once in a while and may even stop on its own. In this case, blood thinners, such as aspirin or warfarin are used to prevent clots from forming. If the episodes occur often or are long-lasting, there is an increased risk that blood clots will form in the heart and, if dislodged, they could cause a stroke. Although there are many treatment options for atrial flutter, the problem can be difficult to "cure" and if the episodes occur often, it can be a very frustrating problem for patients and families. They can be short, ending on their own, or can persist for long periods of time or until treated. The episodes vary in frequency and severity. Although the symptoms can be quite alarming to the child and parents, this is generally not a life-threatening problem. Symptoms of atrial flutter include palpitations (a sensation of rapid or "skipping" heart beats), dizziness, fainting, and fatigue. How does this problem affect my child's health? Therefore, even though the atria are going 300 beats a minute, the actual ventricular heart rate (which causes the "pulse") is usually between 110 and 150 beats per minute. In most people with atrial flutter, the AV node blocks many of the atrial beats from reaching the heart’s lower chambers-the ventricles. Atrial flutter occurs when an electrical impulse travels in a circle around the atria like "a dog chasing its own tail." This happens when there are areas of slow and fast conduction in the atria, which is quite common after having surgery in this area. Click here to learn more about the normal heart rhythm. The incidence of atrial flutter increases over time after these operations. The operations associated with resulting atrial flutter include the Fontan procedure, Mustard or Senning procedure, repair of tetralogy of Fallot, repair of total anomalous venous connection, and repair of atrial septal defect. Atrial flutter is uncommon in the young except when there is a history of heart surgery involving the atria. Atrial flutter is an abnormal, rapid heart rhythm that comes from the heart’s upper chambers - the atria - causing them to beat at rates of 220 to 300 times a minute.
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