What is the most appropriate initial investigation to evaluate a patient with atrial flutter presenting with palpitations and shortness of breath?

The most appropriate initial investigation to evaluate a patient with atrial flutter presenting with palpitations and shortness of breath is an echocardiogram (ECHO) to assess for structural abnormalities. Atrial flutter can be associated with underlying heart disease, and conducting an ECHO allows clinicians to visualize the heart's structure and function. It can help identify conditions such as left ventricular hypertrophy, valvular heart diseases, or other structural issues that could contribute to atrial flutter and its symptoms.

This imaging technique is non-invasive and provides valuable information about the heart’s chambers, valves, and any potential areas of abnormality that could be responsible for the arrhythmia. Understanding the structural context is essential for determining the appropriate management and potential interventions for the patient.

In contrast, the other investigations mentioned have specific indications but are not as immediately appropriate for the initial assessment of a patient with symptoms related to atrial flutter. For instance, CT angiography might be useful in evaluating pulmonary embolism or aortic pathology, but it is not the primary investigation for arrhythmias. Cardiac catheterization is invasive and primarily used for assessing coronary artery disease or hemodynamic evaluation, rather than as an initial step in the evaluation of atrial flutter. Holter