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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. | ||
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: | ||
* '''Cherchez le P''', French for ''find the P waves''. | * '''Cherchez le P''', French for ''find the P waves''. | ||
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** Is every P wave followed by a QRS complex? And every QRS preceded by a P wave? In short: | ** 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 [[Conduction|PR interval]] and does it change? | ||
*What is the ventricular [[Rate|heart rate]]? | *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 [[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> | ||
*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> | *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> | ||