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Arrhythmias can be subdivided into supraventricular

Introduction to Arrhythmias

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.

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 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?
Is there a 1:1 relation between P waves and QRS complexes? If not there may be AV dissociation due to a Ventricular Arrhythmias or AV block
Is every P wave followed by a QRS complex? And every QRS preceded by a P wave?
What is the PR interval and does it change?
What is the QRS width?
If the QRS < 120ms (i.e. a narrow complex), then it is either a sinus arrhythmia, supraventricular rhythm or a junctional tachycardia. In tachycardias, this flowchart will lead to the right diagnosis.[1]
If the QRS > 120ms it is either a ventricular tachycardia or a supraventricular rhythm with additional bundle branch block. This is a challenging diagnosis. Therefore a flowchart which incoporates the Brugada criteria for VT should be used.[2] Another method to discriminate VT from SVT has been proposed by Vereckei et al.[3]In that paper an excellent review is given on the subject by Dendi and Josephson.[4]
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.

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