RT Journal
A1 Tanawuttiwat T, Mitrani RD
T1 FLutter waves in a dialysis patient
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 2011
FD October 10
VO 171
IS 18
SP 1622
OP 1622
DO 10.1001/archinternmed.2011.462
UL http://dx.doi.org/10.1001/archinternmed.2011.462
AB 
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).