Introduction to Arrhythmias: Difference between revisions
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A good stepwise approach to interprete the heart rhythm is to follow these steps: | A good stepwise approach to interprete the heart rhythm is to follow these steps: | ||
*What is the '''ventricular [[Rate|heart rate]]'''? | |||
**>100 bpm = tachycardia | |||
**<60 bpm = bradycardia | |||
**are there extra beats? -> [[Ectopic Beats]] | |||
* '''Cherchez le P''', French for ''find the P waves''. | * '''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. | ** Do you see P waves? Leads II and V1 are often most suitable to find P waves. | ||
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* What is the '''relationship between P waves and QRS complexes'''? | * What is the '''relationship between P waves and QRS complexes'''? | ||
** Is there a 1:1 relation between P waves and QRS complexes? If not there may be [[AV dissociation]] due to a [[Ventricular arrhythmia]] or [[AV conduction|AV block]] | ** Is there a 1:1 relation between P waves and QRS complexes? If not there may be [[AV dissociation]] due to a [[Ventricular arrhythmia]] or [[AV conduction|AV block]] | ||
** Is every P wave followed by a QRS complex? And every QRS preceded by a P wave? | ** Is every P wave followed by a QRS complex? And every QRS preceded by a P wave? | ||
** What is the [[Conduction|PR interval]] and does it change? | ** What is the [[Conduction|PR interval]] and does it change? | ||
* What is the '''[[Conduction|QRS width]]'''? | * What is the '''[[Conduction|QRS width]]'''? | ||
**If the QRS < 120ms (i.e. a narrow complex), then it is either a [[Sinus node rhythms and arrhythmias|sinus arrhythmia]], [[Supraventricular Rhythms|supraventricular rhythm]] or a [[Junctional Tachycardias|junctional tachycardia]]. In tachycardias, this [[Media:narrow_tachycardia_flow.png|'''flowchart''']] will lead to the right diagnosis.<cite>ESCnarrowQRS</cite> | **If the QRS < 120ms (i.e. a narrow complex), then it is either a [[Sinus node rhythms and arrhythmias|sinus arrhythmia]], [[Supraventricular Rhythms|supraventricular rhythm]] or a [[Junctional Tachycardias|junctional tachycardia]]. In tachycardias, this [[Media:narrow_tachycardia_flow.png|'''flowchart''']] will lead to the right diagnosis.<cite>ESCnarrowQRS</cite> | ||
Revision as of 00:33, 6 May 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.
A good stepwise approach to interprete the heart rhythm is to follow these steps:
- What is the ventricular heart rate?
- >100 bpm = tachycardia
- <60 bpm = bradycardia
- are there extra beats? -> Ectopic Beats
- 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 there a 1:1 relation between P waves and QRS complexes? If not there may be AV dissociation due to a Ventricular arrhythmia or AV block
- Is every P wave followed by a QRS complex? And every QRS preceded by a P wave?
- What is the PR interval and does it change?
- What is the QRS width?
- 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]
- What is the clinical setting?
- A wide complex tachycardia in a hemodynamically instable 70 year old man with previous myocardial infarction should be concidered a ventricular tachycardia until proven otherwise
- A wide complex tachycardia in a 24 year old women with recurrent spells of tachycardia the respond to vagal manouevres is most likely an AVNRT with aberrant conduction.
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: