Joan was part of a team working with the Vascular Surgeon who was performing a fistulagram. Joan noted that the patient had an irregular heart rhythm, and atrial flutter. Knowing that early this year when the patient had an EKG, it read Normal Sinus Rhythm. Joan brought this to the attention of the physician. They were unaware that this patient was in an irregular heart rhythm. Untreated, Atrial Fibrillation / Flutter can lead to blood clots that in turn leads to potential stroke, heart failure, and other heart-related complications. By, not only identifying this rhythm but also informing the physician, this patient will be treated for this new condition and decrease the risk of future complications.