4,199
edits
mNo edit summary |
mNo edit summary |
||
(9 intermediate revisions by 4 users not shown) | |||
Line 4: | Line 4: | ||
|supervisor= | |supervisor= | ||
}} | }} | ||
[[Image: | [[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 | 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 | 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]]'''? | *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]] | ||
* '''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. | ||
Line 22: | Line 23: | ||
* 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:Svt_algorythm_en.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: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 | **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? | * 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. | ** 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'''? | * What is the '''clinical setting'''? | ||
** A wide complex tachycardia in a hemodynamically | ** 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 | ** 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== | ==References== | ||
<biblio> | <biblio> |