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Challenges in Clinical Electrocardiography |

Flutter Waves in a Dialysis Patient

Tanyanan Tanawuttiwat, MD; Raul D. Mitrani, FHRS
Arch Intern Med. 2011;171(18):1622. doi:10.1001/archinternmed.2011.462.
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A 59-year-old African American morbidly obese woman with a medical history of ischemic cardiomyopathy (ejection fraction of 35%), hypertension, diabetes, chronic kidney disease, and obstructive sleep apnea presented with worsening shortness of breath. Her initial physical examination revealed a blood pressure of 83/62 mm Hg, heart rate of 69/min, jugular venous distension, bilateral pulmonary rales, and anasarca. She was diagnosed as having acute decompensated heart failure and was treated with aggressive diuresis. Despite the improvement of her respiratory status and blood pressure, her renal function deteriorated. She eventually required continuous venovenous hemodialysis (CVVHD). Subsequently, 24-hour electrocardiogram (ECG) telemetry monitoring and 12-lead ECG appeared to show new-onset atrial flutter (Figure 1).

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Figure 1. The 12-lead electrocardiogram after 24-hour electrocardiogram monitoring appeared to show new-onset flutter waves.

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