Introduction to Arrhythmias: Difference between revisions

Introduction to Arrhythmias (view source)

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 ** What is the [[rate]] of the P waves?
 ** What is the [[P wave morphology]]?
-* What is the relationship between P waves and QRS complexes?
+* 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?
+** 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? In short:
 ** What is the [[Conduction|PR interval]] and does it change?
 *What is the ventricular [[Rate|heart rate]]?
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 **<60 bpm = bradycardia
 **are there extra beats? -> [[Ectopic Beats]]
-* What is the [[QRS morphology]]?
+* 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 it is either a [[Ventricular Arrhythmias|ventricular tachycardia]] or a [[Supraventricular Rhythms|supraventricular rhythm]] with additional [[Intraventricular Conduction|bundle branch block]]. This is a challenging difficulty in arrhythmia diagnosis, therefore a [[media:wideQRS_tachycardia_flow.png|'''flowchart''']] might help, which incoporates the Brugada criteria for VT.<cite>Brugada</cite> Another method to discriminate VT from SVT has been proposed by Vereckei et al.<cite>vereckei</cite> In the editorial on that paper an excellent review is given on the subject by Dendi and Josephson.<cite>dendi</cite>
 * 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.
-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 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 it is either a [[Ventricular Arrhythmias|ventricular tachycardia]] or a [[Supraventricular Rhythms|supraventricular rhythm]] with additional [[Intraventricular Conduction|bundle branch block]]. This is a challenging difficulty in arrhythmia diagnosis, therefore a [[media:wideQRS_tachycardia_flow.png|'''flowchart''']] might help, which incoporates the Brugada criteria for VT.<cite>Brugada</cite> Another method to discriminate VT from SVT has been proposed by Vereckei et al.<cite>vereckei</cite> In the editorial on that paper an excellent review is given on the subject by Dendi and Josephson.<cite>dendi</cite>
 ==References==