Which of the following conditions can cause an atrial flutter?

Atrial flutter can indeed be caused by a variety of underlying conditions, and this includes coronary artery disease, heart failure, and pulmonary embolism. Each of these factors contributes to the structural and electrical changes within the heart that can lead to the development of atrial flutter.

Coronary artery disease can lead to ischemia, affecting the heart muscle's electrical conduction pathways, making it more susceptible to arrhythmias such as atrial flutter.

Heart failure is another significant factor, as it often involves changes in the atrial size and pressure dynamics, which can result in reentrant circuits in the atria, promoting the occurrence of atrial flutter.

Pulmonary embolism can cause acute strain on the right side of the heart, leading to right atrial enlargement and increased pressures, which can trigger atrial flutter as a result of these acute changes in atrial stress and stretch.

Because all these conditions can lead to similar mechanisms of atrial irritation and conduction abnormalities, they can all simultaneously contribute to the development of atrial flutter. Therefore, the answer encompasses all these factors correctly, indicating that any or all may precipitate this arrhythmia.