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==What is the cardiac frequency?==
|previouspage=Rhythm
[[Image:ECGpapier.png|thumb| The width of a square on the ECG represents time]]
|previousname=Step 1: Rhythm
[[Image:Ecgfreq.png|thumb| De aftelmethode om de hartfrequentie te bepalen. Het tweede QRS-complex ligt tussen de ''75'' en de ''60'' slagen per minuut. Deze hartslag ligt daar dus tussenin, rond de 65 slagen per minuut. ]]
|nextpage=Conduction
|nextname=Step 3:Conduction intervals (PQ, QRS, QT, QTc)
}}
[[Image:ECGpapier.png|thumb|300px| The width of a square on the ECG represents time]]
[[Image:Ecgfreq.png|thumb|300px| The count method to determine the heart frequency. The second QRS complex is between ''75'' and ''60'' beat per minute. This heartbeat is between that, around 65 beats per minute.]]
'''What is the heart rate?'''
To answer this question, determine the time between two QRS complexes. Previously, the ECG was printed on a paper strip transported through an ECG writer at the speed of 25 mm/second. Now, digital ECGs are common; however, the method for determining the frequency remains the same. The ECG has a grid with thick lines 5 mm apart (= 0,20 second) and thin lines 1 mm (0,04 second).


To anwere this question, determine the time between two QRS complexes. Previously, the ECG was registered on a paperstrip transported through an ECG writer at the speed of 25 mm/second. Nowadays, digital ECG registration is common however, the method of determining the frequency remains the same. The ECG paper has a grid with thick lines 5 mm apart (= 0,20 second) and thin lines 1 mm (0,04 second).
There are three simple methods to determine the heart rate (HR)


{| class="wikitable"
!The square counting method
|-
| The '''square counting''' method is ideal for regular heart rates. Use the sequence 300-150-100-75-60-50-43-37. Count from the first QRS complex, the first thick line is 300, the next thick line 150 etc. Stop the sequence at the next QRS complex. When the second QRS complex is between two lines, take the mean of the two numbers from the sequence or use the fine-tuning method listed below.
|}


'''There are three simple methods to determine the hart frquency (HF):'''
{| class="wikitable"
# Count the small (1mm) lines between two QRS-complexes. Hens, the ECG paper runs with 25 mm/sec through the ECG writer, therefore:&nbsp;&nbsp;&nbsp;[[Afbeelding:HFformule.png]]This method work fine in case of tacycardia (>100 beats/minute)<br>
!Use a calculator
# To determine the frequency of a normal sinus ritme: Use the sequence 300-150-100-75-60-50-43-37. Count from the first QRS complex, the first thick line is 300, the next line 150 etc. Stop the sequence at the next QRS complex. When the second QRS complex is in between two lines, take the mean of the two numbers from the sequence. You can finetune this method with the following more precise sequence: *'''300'''''-250-214-187-167-'''''150'''
|-
*'''150'''''-136-125-115-107-'''''100'''
| Count the small (1mm) squares between two QRS complexes. The ECG paper runs at 25 mm/sec through the ECG printer; therefore:[[Image:HFformule_en.png|none]]This method works well in case of tachycardia (>100 beats/minute)<br>
*'''100'''''-94-88-83-79-'''''75'''
|}
*'''75'''''-71-68-65-62-'''''60'''
# Non regular ritmes are best determined with the "3 second marker method" Count the number of QRS-complexes that fitt in 3 seconds (some ECG writers register this period on the ECG paper. Multiply this number by 20 and find the number of beats/minute.


{| class="wikitable"
!The marker method
|-
|
Non-regular rhythms are best determined with the "3 second marker method". Count the number of QRS complexes that fit into 3 seconds (some ECG writers print this period on the ECG paper). Multiply this number by 20 to find the number of beats/minute.
|}
{| class="wikitable" font-size="90%" align="center"
|+'''The 'square counting' method can be fine-tuned with the following sequence'''
|-
|'''300'''||250||214||187||167||'''150'''||136||125||115||107||'''100'''||94||88||83||79||'''75'''||71||68||65||62||'''60'''
|-
|}
{{clr}}
{{clr}}


==Wat beïnvloedt de hartfrequentie?==
==What changes the frequency of the heart?==
De hartfrequentie wordt door een groot aantal factoren bepaald.
A number of factors change the heart frequency, including:
* Het autonome zenuwstelsel, de sympathicus en parasympathicus.  
* the (para) sympathic nervous system.  
** Het '''sympathisch systeem''' o.i.v. epinephrine (=adrenaline) leidt bij activatie tot een toename in atrioventriculaire geleiding, prikkelbaarheid en contractiliteit. (in de oertijd goed voor: ''fight, fright, flight'')
** The '''sympathic system''', e.g. epinephrine, (=adrenalin) increases atrioventricular conduction and contractility (the ''fight or flight'' reaction.)
** Het parasympathische systeem (nervus vagus) o.i.v. acetycholine leidt daarentegen bij activatie  tot een afname in frequentie van de SA-knoop, atrioventriculaore voortgeleiding en prikklebaarheid. In tegenstelling tot het sympathisch systeem werkt het parasympathicus voornamelijk op de atria.
** The parasympathic system (nervus vagus,) e.g. acetycholine, decreases the frequency and atrioventricular conduction. The parasympathic system affects mainly the atria.
* De vulling van het hart. Bij ondervulling gaat de frequentie omhoog
* Cardiac filling increases the frequency.
*  [[arrhythmias]] influence heart rate.
 
[[Category:ECG Course]]

Latest revision as of 19:51, 15 March 2011

«Step 1: Rhythm Step 3:Conduction intervals (PQ, QRS, QT, QTc)»


The width of a square on the ECG represents time
The count method to determine the heart frequency. The second QRS complex is between 75 and 60 beat per minute. This heartbeat is between that, around 65 beats per minute.

What is the heart rate? To answer this question, determine the time between two QRS complexes. Previously, the ECG was printed on a paper strip transported through an ECG writer at the speed of 25 mm/second. Now, digital ECGs are common; however, the method for determining the frequency remains the same. The ECG has a grid with thick lines 5 mm apart (= 0,20 second) and thin lines 1 mm (0,04 second).

There are three simple methods to determine the heart rate (HR)

The square counting method
The square counting method is ideal for regular heart rates. Use the sequence 300-150-100-75-60-50-43-37. Count from the first QRS complex, the first thick line is 300, the next thick line 150 etc. Stop the sequence at the next QRS complex. When the second QRS complex is between two lines, take the mean of the two numbers from the sequence or use the fine-tuning method listed below.
Use a calculator
Count the small (1mm) squares between two QRS complexes. The ECG paper runs at 25 mm/sec through the ECG printer; therefore:
HFformule en.png
This method works well in case of tachycardia (>100 beats/minute)
The marker method

Non-regular rhythms are best determined with the "3 second marker method". Count the number of QRS complexes that fit into 3 seconds (some ECG writers print this period on the ECG paper). Multiply this number by 20 to find the number of beats/minute.

The 'square counting' method can be fine-tuned with the following sequence
300 250 214 187 167 150 136 125 115 107 100 94 88 83 79 75 71 68 65 62 60


What changes the frequency of the heart?

A number of factors change the heart frequency, including:

  • the (para) sympathic nervous system.
    • The sympathic system, e.g. epinephrine, (=adrenalin) increases atrioventricular conduction and contractility (the fight or flight reaction.)
    • The parasympathic system (nervus vagus,) e.g. acetycholine, decreases the frequency and atrioventricular conduction. The parasympathic system affects mainly the atria.
  • Cardiac filling increases the frequency.
  • arrhythmias influence heart rate.
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