Introduction to Arrhythmias: Difference between revisions
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Arrhythmias (non-normal heart rhythms) can be a challenge to the person who tries to understand them. But with a systematical approach, diagnosis is often less difficult than it seems at the beginning. | Arrhythmias (non-normal heart rhythms) can be a challenge to the person who tries to understand them. But with a systematical approach, diagnosis is often less difficult than it seems at the beginning. | ||
''' | ==Interpretation of the heart rhythm== | ||
A good stepwise approach to interprete the heart rhythm is to follow these steps: | |||
* '''Cherchez le P''', French for ''find the P waves''. | |||
** Do you see P waves? Leads II and V1 are often most suitable to find P waves. | |||
** What is the [[rate]] of the P waves? | |||
** What is the [[P wave morphology]]? | |||
* What is the relationship between P waves and QRS complexes? | |||
** Is every P wave followed by a QRS complex? And every QRS preceded by a P wave? In short: is there a 1:1 relation between P waves and QRS complexes? | |||
** What is the [[Conduction|PR interval]] and does it change? | |||
*What is the ventricular [[Rate|heart rate]]? | |||
*>100 bpm = tachycardia | *>100 bpm = tachycardia | ||
*<60 bpm = bradycardia | *<60 bpm = bradycardia | ||
*are there extra beats? -> [[Ectopic Beats]] | *are there extra beats? -> [[Ectopic Beats]] | ||
* What is the [[QRS morphology]]? | |||
* What is the clinical setting? | |||
Secondly it is important to assess the '''origin of the arrhythmia''': | Secondly it is important to assess the '''origin of the arrhythmia''': | ||
Revision as of 15:54, 1 February 2009
| Author(s) | J.S.S.G. de Jong | |
| Moderator | J.S.S.G. de jong | |
| Supervisor | ||
| some notes about authorship | ||
Morphologic criteria to differentiate between SVT vs. VT in a wide complex tachycardia. This is part of the wide complex tachycardia flowchart
Arrhythmias (non-normal heart rhythms) can be a challenge to the person who tries to understand them. But with a systematical approach, diagnosis is often less difficult than it seems at the beginning.
Interpretation of the heart rhythm
A good stepwise approach to interprete the heart rhythm is to follow these steps:
- Cherchez le P, French for find the P waves.
- Do you see P waves? Leads II and V1 are often most suitable to find P waves.
- What is the rate of the P waves?
- What is the P wave morphology?
- What is the relationship between P waves and QRS complexes?
- Is every P wave followed by a QRS complex? And every QRS preceded by a P wave? In short: is there a 1:1 relation between P waves and QRS complexes?
- What is the PR interval and does it change?
- What is the ventricular heart rate?
- >100 bpm = tachycardia
- <60 bpm = bradycardia
- are there extra beats? -> Ectopic Beats
- What is the QRS morphology?
- What is the clinical setting?
Secondly it is important to assess the origin of the arrhythmia:
- If the QRS < 120ms (i.e. a narrow complex), then it is either a sinus arrhythmia, supraventricular rhythm or a junctional tachycardia. In tachycardias, this flowchart will lead to the right diagnosis.[1]
- If the QRS > 120ms it is either a ventricular tachycardia or a supraventricular rhythm with additional bundle branch block. This is a challenging difficulty in arrhythmia diagnosis, therefore a flowchart might help, which incoporates the Brugada criteria for VT.[2] Another method to discriminate VT from SVT has been proposed by Vereckei et al.[3] In the editorial on that paper an excellent review is given on the subject by Dendi and Josephson.[4]
References
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Error fetching PMID 2022022:
Error fetching PMID 17272358:
Error fetching PMID 17317697:
- Error fetching PMID 14563598:
- Error fetching PMID 2022022:
- Error fetching PMID 17272358:
- Error fetching PMID 17317697: