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Episode 72 – Atrial Flutter

Scott Giles, PT, DPT, MBA
Posted 08/12/2025

Watch the video version of this episode on YouTube - https://youtu.be/eXsure_4i_I

A patient with atrial flutter suddenly becomes extremely lightheaded while exercising and appears to lose consciousness. Which of the following physiologic responses BEST explains the change in the patient’s status? 

1. Increased filling of the ventricles
2. Increased system congestion
3. Decreased atrial depolarization
4. Decreased blood traveling to the brain

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A patient with atrial flutter suddenly becomes extremely lightheaded while exercising and appears to lose consciousness. Which of the following physiologic responses BEST explains the change in the patient’s status? 

1. Increased filling of the ventricles
2. Increased system congestion
3. Decreased atrial depolarization
4. Decreased blood traveling to the brain

Atrial Flutter
Atrial flutter is a common abnormal heart rhythm characterized by rapid atrial tachycardia. This rapid rate creates decreased filling time of the ventricles resulting in diminished amounts of blood being ejected from the heart. This form of arrhythmia produces sawtooth-shaped P waves.

Let’s explore each of the options:
Option 1 - Increased filling of the ventricles
The rapid rate of atrial contraction (i.e., 250-350 beats per minute) associated with atrial flutter results in decreased filling time of the ventricles and diminished amounts of blood being ejected from the heart.

Option 1 indicates “increased, not decreased”, filling of the ventricles

Option 2 - Increased system congestion
Increased system congestion is more characteristic of congestive heart failure than atrial flutter.

Congestive heart failure is often caused by diminished pumping ability of the ventricles due to muscle weakening (systolic dysfunction) or to stiffening of the heart muscle that impairs the ventricles’ capacity to relax and fill (diastolic dysfunction).

Option 3 - Decreased atrial depolarization
Atrial flutter is characterized by an extremely rapid rate of atrial depolarization, not a decreased rate.

This rapid rate creates decreased filling time of the ventricles resulting in diminished amounts of blood being ejected from the heart.

Option 4 - Decreased blood traveling to the brain
Atrial flutter results in decreased blood traveling to the brain as well as other areas of the body.

As a result, vital organs such as the heart muscle and brain may not receive enough blood causing mild symptoms (e.g., palpitations, lightheadedness, weakness) or more serious symptoms (e.g., fainting, angina, organ failure).

The correct answer is Option 4

All Student Results
4% of students selected Option 1, Increased filling of the ventricles
3% of students selected Option 2, Increased system congestion
26% of students selected Option 3, Decreased atrial depolarization
67% of students selected Option 4, Decreased blood traveling to the brain - the correct response

System Classification
This question is a Cardiovascular and Pulmonary Systems question which represents approximately 14% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 1 question since the question requires students to possess basic foundational academic knowledge. Remediation of Level 1 questions occurs through academic review of entry-level content using textbooks, review books, Basecamp, and flash cards.

Academic Focus Area
Looking to review related academic content? Check out page 437 in PTEXAM: The Complete Study Guide. Thanks for joining us on the Scorebuilders Q and A podcast!

See you next week!