if the P waves are about 300 per minute, and there is a 3:1 block, then the ECG will have a characteristic saw-tooth appearance
if atrial flutter is associated with a 2:1 block, P waves are difficult to recognise because of the superposition of the preceding T waves
flutter waves are most clearly seen in V1, II, III & aVF
an uncertain diagnosis can be confirmed if carotid sinus pressure results in an increase in the uncoupling of the atria and ventricles, revealing the flutter waves
always consider atrial flutter if a patient has a regular tachycardia of 150
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