Difference between revisions of "Introduction to Arrhythmias"

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[[Image:VT_SVT_LBBB_WCT.svg|thumb|300px|Morphologic criteria to differentiate between SVT vs. VT in a wide complex tachycardia. This is part of the [[media:wideQRS_tachycardia_flow.png|wide complex tachycardia flowchart]]]]
 
[[Image:VT_SVT_LBBB_WCT.svg|thumb|300px|Morphologic criteria to differentiate between SVT vs. VT in a wide complex tachycardia. This is part of the [[media:wideQRS_tachycardia_flow.png|wide complex tachycardia flowchart]]]]
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.
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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 interprete the heart rhythm is to follow these steps:
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A good stepwise approach to interpret the heart rhythm is to follow these steps:
 
*What is the '''ventricular [[Rate|heart rate]]'''?
 
*What is the '''ventricular [[Rate|heart rate]]'''?
 
**>100 bpm = tachycardia
 
**>100 bpm = tachycardia
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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 instable 70 year old man with previous myocardial infarction should be concidered a [[ventricular tachycardia]] until proven otherwise
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** 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 24 year old women with recurrent spells of tachycardia the respond to vagal manouevres is most likely an [[AVNRT]] with aberrant conduction.
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** 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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Revision as of 19:47, 27 January 2010

Author(s) J.S.S.G. de Jong
Moderator J.S.S.G. de jong
Supervisor
some notes about authorship
Morphologic criteria to differentiate between SVT vs. VT in a wide complex tachycardia. This is part of the wide complex tachycardia flowchart

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:

  • What is the ventricular 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?
  • What is the QRS width?
  • What is the 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 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.


References

Error fetching PMID 14563598:
Error fetching PMID 2022022:
Error fetching PMID 17272358:
Error fetching PMID 17317697:
  1. Error fetching PMID 14563598: [ESCnarrowQRS]
  2. Error fetching PMID 2022022: [Brugada]
  3. Error fetching PMID 17272358: [vereckei]
  4. Error fetching PMID 17317697: [dendi]
All Medline abstracts: PubMed | HubMed