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[[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 to understand, but with a systematic approach, diagnosis is often less difficult than it may appear at first. | 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: | 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. | ||
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** 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 unstable 70-year-old man with previous myocardial infarction should be considered a [[ventricular tachycardia]] until proven otherwise | ** 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. | ** 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. | ||
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==References== | ==References== | ||
<biblio> | <biblio> |