Introduction to Arrhythmias: Difference between revisions

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Introduction to Arrhythmias (view source)

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** What is the [[rate]] of the P waves?
** What is the [[rate]] of the P waves?
** What is the [[P wave morphology]]?
** What is the [[P wave morphology]]?
* What is the relationship between P waves and QRS complexes?
* What is the '''relationship between P waves and QRS complexes'''?
** Is every P wave followed by a QRS complex? And every QRS preceded by a P wave? In short: is there a 1:1 relation 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 arrhythmia]] or [[AV conduction|AV block]]
** 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]]?
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**<60 bpm = bradycardia
**<60 bpm = bradycardia
**are there extra beats? -> [[Ectopic Beats]]
**are there extra beats? -> [[Ectopic Beats]]
* What is the [[QRS morphology]]?
* 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 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>
* 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
** 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.


Secondly it is important to assess the '''origin of the arrhythmia''':
*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>


==References==
==References==
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