Supraventricular Rhythms: Difference between revisions

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'''Supraventricular Rhythms originate from the atria. Examples of supraventricular rhythms are:'''
===Supraventricular tachycardias===
*[[Sinustachycardia]]
{| class="wikitable" border="1" width="610px"
*[[Atrial Rhythm]]
|-
*[[Atrial Flutter]]
| [[Image:atrial_ventricular.png|300px]]
*[[Atrial Fibrillation]]
| [[image:SVT_overview.svg|300px]]
*[[Atrial Tachycardia]]
| [[Image:Svt_algorythm_en.png|300px]]
*[[AVRT|Atrio-ventricular Reentry Tachycardia AVRT]]
|-
 
!Arrhythmias are categorized into supraventricular and ventricular depending on their origin (below the bifurcation of the His bundle is ventricular)
'''Supraventricular [[Ectopic Beats|ectopic beats]] can result in:'''
!An overview of pathological supraventricular arrhythmias and their origin
*[[Atrial Premature Complexes]]
!Algorithm to diagnose SVTs<cite>ACC</cite>
*[[Wandering Pacemaker]]
|}
*[[AV-nodal complexes]]
 
'''Also read:'''
*Flowchart: [[Media:narrow_tachycardia_flow.png|Approach to the Narrow Complex Tachycardia]] Adapted from <cite>ESCnarrowQRS</cite>.
*[[Introduction to Arrhythmias]]
*[[Mechanisms of Arrhythmias]]
*[[Sinus node rhythms and arrhythmias]]
*[[Junctional Tachycardias]]
*[[Ventricular Arrhythmias]]
 
 
{| class="wikitable" font-size="90%"
{| class="wikitable" font-size="90%"
|- style="text-align:center;background-color:#6EB4EB;"
|- style="text-align:center;background-color:#6EB4EB;"
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|-
|-
!
!
!example
!Example (lead II)
!regularity
!Regularity
!atrial frequency
!Atrial frequency
!ventricular frequency
!Ventricular frequency
!origin (SVT/VT)
!Origin (SVT/VT)
!p-wave
!P-wave
!effect of adenosine
![[Effect of adenosine]]
|-  
|-  
| colspan="8" style="text-align:left;background-color:#cfefcf;" | '''Narrow complex (QRS<0.12)'''
| colspan="8" style="text-align:left;background-color:#cfefcf;" | '''Narrow complex (QRS<0.12)'''
|-
|-
! [[Sinustachycardia]]
! [[Sinustachycardia]]
| [[Image:sinustachy_small.svg|200px]]
| [[Image:sinustachy_small.svg|200px|Sinustachycardia - a normal p wave precedes every QRS complex]]
| regular
| regular
| 100-180 bpm
| 100-180 bpm
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|-
|-
! [[Atrial Fibrillation]]
! [[Atrial Fibrillation]]
| [[Image:afib_small.svg|200px]]
| [[Image:afib_small.svg|200px|Atrial fibrillation - irregular rate, no p waves]]
| grossly irregular
| grossly irregular
| 400-600 bpm  
| 400-600 bpm  
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|-
|-
! [[Atrial Flutter]]
! [[Atrial Flutter]]
| [[Image:aflutt_small.svg|200px]]
| [[Image:aflutt_small.svg|200px|Atrial flutter - sawtooth in lead II with 2:1 block]]
| regular (sometimes alternating block)  
| regular (sometimes alternating block)  
| 250-350 bpm  
| 250-350 bpm  
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|-
|-
! [[AVNRT]]  
! [[AVNRT]]  
| [[Image:avnrt_small.svg|200px]]
| [[Image:avnrt_small.svg|200px|ANVRT - rSR' in lead V1]]
| regular  
| regular  
| 180-250 bpm
| 180-250 bpm
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|-
|-
! [[Atrial Tachycardia]]
! [[Atrial Tachycardia]]
| [[Image:atrialtachy_small.svg|200px]]
| [[Image:atrialtachy_small.svg|200px|Atrial tachycardia - like sinustachycardia but the p wave has a different morphology]]
| regular
| regular
| 120-250 bpm  
| 120-250 bpm  
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|-
|-
! [[AVRT|Atrio-Ventricular Reentry Tachycardia (AVRT)- orthodromic]]
! [[AVRT|Atrio-Ventricular Reentry Tachycardia (AVRT)- orthodromic]]
|
| [[Image:avrt_small.svg|200px|AVRT - inverted p wave behind every QRS complex]]
| regular  
| regular  
| 150-250 bpm
| 150-250 bpm
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|-
|-
! [[AVJT|AV junctional tachycardia]]
! [[AVJT|AV junctional tachycardia]]
| [[Image:avnodal_small.svg|200px]]
| [[Image:avnodal_small.svg|200px|AV junctional tachycardia - no or inverted p-waves within QRS complex]]
| regular  
| regular  
| 60-100 bpm
| 60-100 bpm
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|-
|-
! [[Supraventricular tachycardia with block]]
! [[Supraventricular tachycardia with block]]
|
| [[Image:atrial_tachy_with_LBBB_leadII.svg|200px|SVT with block - any SVT combined with LBBB or RBBB]]
| (ir)regular depending on SVT
| (ir)regular depending on SVT
| 150-250 bpm
| 100-250 bpm
| 75-200 bpm
| 75-200 bpm
| atria (SVT)
| atria (SVT)
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|-
|-
! [[AVRT|Atrio-ventricular Reentry Tachycardia (AVRT) - antidrome]]
! [[AVRT|Atrio-ventricular Reentry Tachycardia (AVRT) - antidrome]]
|
|  
| regular  
| regular  
| 150-250 bpm
| 150-250 bpm
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|}
|}


{{Box|
===Supraventricular [[Ectopic Beats|ectopic beats]]===
*[[Atrial Premature Complexes]]
*[[Wandering Pacemaker]]
*[[AV-nodal complexes]]
}}
{{Box|
===Also read===
*[[Introduction to Arrhythmias]]
*[[Mechanisms of Arrhythmias]]
*[[Sinus node rhythms and arrhythmias]]
*[[Junctional Tachycardias]]
*[[Ventricular Arrhythmias]]
}}
{{Box|
==References==
==References==
<biblio>
<biblio>
#ESCnarrowQRS pmid=14563598
#ACC pmid=14563598
</biblio>
</biblio>
}}
[[Category:ECG Textbook]]

Latest revision as of 19:09, 23 August 2011

Author(s) J.S.S.G. de Jong
Moderator J.S.S.G. de jong
Supervisor
some notes about authorship

Supraventricular tachycardias

Atrial ventricular.png SVT overview.svg Svt algorythm en.png
Arrhythmias are categorized into supraventricular and ventricular depending on their origin (below the bifurcation of the His bundle is ventricular) An overview of pathological supraventricular arrhythmias and their origin Algorithm to diagnose SVTs[1]
An overview of supraventricular tachycardias
Example (lead II) Regularity Atrial frequency Ventricular frequency Origin (SVT/VT) P-wave Effect of adenosine
Narrow complex (QRS<0.12)
Sinustachycardia Sinustachycardia - a normal p wave precedes every QRS complex regular 100-180 bpm 100-180 bpm sinusnode (SVT) precedes every QRS complex gradual slowing
Atrial Fibrillation Atrial fibrillation - irregular rate, no p waves grossly irregular 400-600 bpm 75-175 bpm atria (SVT) absent slows down rate; irregularity remains
Atrial Flutter Atrial flutter - sawtooth in lead II with 2:1 block regular (sometimes alternating block) 250-350 bpm 75-150 bpm (3:1 or 2:1 block is most common) atria (SVT) negative sawtooth in lead II temporary reduced conduction (e.g. 4:1)
AVNRT ANVRT - rSR' in lead V1 regular 180-250 bpm 180-250 bpm AV-node (SVT) in QRS complex (R') stops
Atrial Tachycardia Atrial tachycardia - like sinustachycardia but the p wave has a different morphology regular 120-250 bpm 75-200 bpm atria precedes QRS, p wave differs from sinus-p temporary AV-block
Atrio-Ventricular Reentry Tachycardia (AVRT)- orthodromic AVRT - inverted p wave behind every QRS complex regular 150-250 bpm 150-250 bpm circle: av-node - ventricles - bypass - atria RP < PR stops
AV junctional tachycardia AV junctional tachycardia - no or inverted p-waves within QRS complex regular 60-100 bpm 70-130 bpm AV node RP < PR reduces rate
Wide complex (QRS>0.12)
Supraventricular tachycardia with block SVT with block - any SVT combined with LBBB or RBBB (ir)regular depending on SVT 100-250 bpm 75-200 bpm atria (SVT) absent temporary increased AV-block (eg 4:1)
Atrio-ventricular Reentry Tachycardia (AVRT) - antidrome regular 150-250 bpm 150-250 bpm circular: bypass - atria - av-node - ventricles RP < PR stops




References

  1. Blomström-Lundqvist C, Scheinman MM, Aliot EM, Alpert JS, Calkins H, Camm AJ, Campbell WB, Haines DE, Kuck KH, Lerman BB, Miller DD, Shaeffer CW, Stevenson WG, Tomaselli GF, Antman EM, Smith SC Jr, Alpert JS, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Hiratzka LF, Hunt SA, Jacobs AK, Russell RO Jr, Priori SG, Blanc JJ, Budaj A, Burgos EF, Cowie M, Deckers JW, Garcia MA, Klein WW, Lekakis J, Lindahl B, Mazzotta G, Morais JC, Oto A, Smiseth O, Trappe HJ, and European Society of Cardiology Committee, NASPE-Heart Rhythm Society. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. a report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol. 2003 Oct 15;42(8):1493-531. DOI:10.1016/j.jacc.2003.08.013 | PubMed ID:14563598 | HubMed [ACC]
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