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Introduction to Arrhythmias: Difference between revisions
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{{authors| | |||
*[[Sinus node rhythms and arrhythmias]] | |mainauthor= [[user:Drj|J.S.S.G. de Jong]] | ||
|moderator= [[user:Drj|J.S.S.G. de jong]] | |||
|supervisor= | |||
}} | |||
[[Image:Atrial_ventricular.png|thumb|300px|Arrhythmias can be subdivided into supraventricular, nodal and ventricular arrhythmias]] | |||
Arrhythmias (non-normal heart rhythms) can be a challenge to understand, but with a systematic approach, diagnosis is often less difficult than it may appear at first. | |||
A good stepwise approach to interpret the heart rhythm is to follow these steps: | |||
*Is this my patient's ECG or is this an artifact? (applies especially in stressfull situations) | |||
*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''. | |||
** 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 Arrhythmias]] or [[AV Conduction|AV block]] | |||
** 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|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:Svt_algorythm_en.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 diagnosis. Therefore a [[media:wideQRS_tachycardia_flow.png|'''flowchart''']] which incoporates the Brugada criteria for VT should be used.<cite>Brugada</cite> Another method to discriminate VT from SVT has been proposed by Vereckei et al.<cite>vereckei</cite>In that paper an excellent review is given on the subject by Dendi and Josephson.<cite>dendi</cite> | |||
* What is the '''[[Heart axis|Heart Axis]]''' and did it change? | |||
** If the heart axis turns significantly when compared to the heart axis during sinus rhythm a ventricular origin of the rhythm is more likely. | |||
* What is the '''clinical setting'''? | |||
** A wide complex tachycardia in a hemodynamically unstable 70-year-old man with previous myocardial infarction should be considered a [[Vt|ventricular tachycardia]] until proven otherwise | |||
** A wide complex tachycardia in a 24-year-old woman with recurrent spells of tachycardia that respond to vagal maneuvers is most likely an [[AVNRT]] with aberrant conduction. | |||
{{box| | |||
==References== | |||
<biblio> | |||
#ESCnarrowQRS pmid=14563598 | |||
#Brugada pmid=2022022 | |||
#vereckei pmid=17272358 | |||
#dendi pmid=17317697 | |||
</biblio> | |||
}} | |||