Causes

The exact origin of atrial flutter is not yet fully understood. Atrial flutter is promoted by organic heart diseases (coronary heart disease, heart valve diseases, heart muscle diseases, etc.). ), in which damage and scarring of the heart tissue occurs.

Other triggering factors can be emotional stress and excessive alcohol or nicotine abuse. In rare cases, atrial flutter also occurs in healthy patients. However, older people are particularly affected.

With regard to the development of atrial flutter, a typical and an atypical form can be distinguished. The typical (85%) is significantly more frequent than the atypical form (15%). In typical atrial flutter there is a delayed propagation of excitation from the sinus node (located in the right atrium) via the muscles of the atria to the AV node (located at the transition between the atria and the ventricles).

This delay occurs mainly due to scarred heart muscle tissue as a result of organic heart disease. As a result, the atria are unevenly excited. While some areas have already been excited and can be excited again, other muscle cells have not yet been excited.

This creates the danger of a permanent circular excitation within the atria.This often develops around the tricuspid valve (valve between the right atrium and the right ventricle). Subsequently, only every second or third excitation originating from the sinus node is transferred to the ventricles. In atypical atrial flutter, the circular excitation is not located in the area of the tricuspid valve, but can be localized in the entire atrial tissue.

Consequently, atypical atrial flutter is much more difficult to localize and treat. The typical atrial flutter often occurs at preferred sites in the right atrium, for example in the area of scar tissue. Atypical atrial flutter can occur in both the right and left atrium. Preferred sites of origin are anatomical structures or scars.

Associated symptoms

Atrial flutter is often noticed by a fast and possibly irregular pulse. This can also be directly noticeable on the heart by perceiving the heartbeat as fast, strained or irregular. In addition, circulatory weakness or limited exercise tolerance, shortness of breath or a feeling of pressure in the chest may also occur.

It is only because of the symptoms that atrial flutter cannot be distinguished from the more familiar atrial fibrillation. There is a possibility that the flutter may change into atrial fibrillation. Atrial flutter often develops without any symptoms.

The diagnosis is therefore made as a random finding in the ECG. The most common symptom of atrial flutter is an irregular heartbeat. Patients report a fluttering feeling in the chest, so-called palpitations.

This sensation can extend to the neck, giving the patient the feeling that “the heart is beating up to the neck”. In addition, the irregular and sometimes rapid heartbeat can also cause the patient to notice palpitations. Typically, these symptoms occur suddenly during atrial flutter.

They can subside after some time. Accompanying symptoms are often caused by the patient’s unpleasant feeling of a fast and irregular heartbeat. Another symptom of atrial flutter, which occurs mainly during a very fast and irregular heartbeat, is shortness of breath.

The irregular heartbeat means that not enough blood reaches the body’s circulation. The ventricle pumps the blood into the circulation before the chamber is completely filled with blood. As a result, the blood backs up (among other things, in the lungs), which can cause breathing difficulties.

This is often accompanied by shortness of breath. In addition, a pressure on the chest can also be felt. In addition, many patients with atrial flutter report increasing dizziness.

Due to the insufficient pumping function of the heart, the blood supply to the brain is reduced. As a result, short-term clouding of consciousness can occur with the risk of collapse. A short-term, reversible loss of consciousness is also known as syncope.

Due to the reduced blood supply to the brain, other accompanying symptoms can occur in addition to dizziness (paleness, nausea, sweating, etc.). Due to the unpleasant feeling of a fast and irregular heartbeat, a vegetative accompanying symptomatology can occur. In many patients this leads to an activation of the vegetative nervous system (sympathetic nervous system).

As a result, the sweat glands of the body produce more sweat. In addition, the patient may feel anxiety due to the sudden appearance of a fast and irregular heartbeat. By activating the autonomic nervous system, the heartbeat is additionally accelerated and the atrial flutter with its symptoms can be further intensified.