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.


==Interpretation of the heart rhythm==
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>