A nurse on the cardiac telemetry floor is monitoring the electrocardiogram (EKG) of a patient admitted with an elevated heart rate. The nurse notes that the EKG shows an atrial rate of 300 with the P waves in a "saw-tooth" pattern. The AV conduction ratio is 3:1 with a ventricular response rate of 100. The nurse knows this rhythm is which of the following? 

Atrial flutter

Explanation

•Atrial flutter occurs due to a circular pathway in the right atrium where the sinoatrial (SA) node is located.

•The electrical impulse conducts through the cells that are polarized and ready to receive an impulse, resulting in continual re-firing. The AV node will not conduct each of these impulses to the ventricles, so ventricular depolarization stays constant.  The result is the appearance of "flutter" P waves with normal QRS waves.

•Conduction ratio is calculated based on the number of flutter waves for each QRS wave. 

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