75-year-old man with a history of hypertension

intravenous diltiazem

This patient is presenting with symptomatic atrial flutter. Findings on ECG show evidence of atrial flutter with a 2:1 block and a ventricular rate of approximately 150 beats/minute. The next step would be to transfer the patient to the emergency department where an intravenous medication could be provided to slow the heart rate. Cardioversion is not indicated at this point as the patient is not unstable: not hypotensive, no evidence of volume overload on examination, and the patient's mentation is intact.

Atrial flutter usually runs at 150 ventricular beats/minute and 300 atrial beats/minute. In children with atrial flutter, the rate may be as high as 500 atrial beats/minute.

Reference:

Yealy DM, et al. Dysrhythmias. In Marx JA, et al. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed., 2014.