Arrythmia Recognition

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Arrhythmia Recognition An Emergency View



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Cardiac conduction

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ELECTROCARDIOGRAM

³5´ steps approach to arrhythmias

Step1: Is there a ³QRS´

Step2: Is there a ³P´ WaveStep3: What is the relationship between the

P waves and the QRS complexes?Step4: Calculate rate

Step5:Miscellaneous



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1) Is there a ³QRS´

(N o pulse)

YES NO

CH AOTIC FLAT LIN E W IDE N ARR OW

P EA VF AsystoleVT



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A&E VinayakaNo QRS & Flat line



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Wide QRS



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No ³P´ & Varying ³RR´ interval



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1st Degree block(AV Nodal Delay)



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P-R IntervalIST Degree heart block

n³P´ = n³QRS´ ?

P-R interval is >0.2 Sec



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< 0.2

Normal

> 0.2

Io AVB

Constant ?

YesNo

RR intervalIIoType 22AVB

No

Type1 IIo

PR intervalPR interval

HEART BLOCK

n³P´ = n³QRS´ ? No Yes

Constant?

IIIo AVB



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IIIrd Degree heart block

n³P´ is not equal to n³QRS´?

PR intervals are not constant

RR intervals are constant



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n³P´ is not equal to n³QRS´?

PR interval is constant



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IInd Degree Type-I heart block

PROGRESSIVE PROLONGATION OFµP-R¶ INTERVAL

DROPPED µQRS¶ COMPLEX

n³P´ is not equal to n³QRS´ ?

Both PR and RR intervals

are not constant



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4)Calculating Heart

Rates A Count the number of R waves in a

6-second strip and multiply by10.(especially for irregular rhythm)

�Not very accurate

�Used only with very quickestimate



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Calculating Heart

Rates(cont..)B Count the number of large squares between

two consecutive R waves and 300 / Big squares

� Very quick

�Not very accurate with fast rates

�Used only with regular rhythms



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Supraventricular

Tachycardia� Narrow complex

� Regular Rate 140 to 220 / minute



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VT SVT with aberrancy

� Capture beat � Fusion beat

� Concordance

� Time required toreach either the

peak of R wave / the

nadir of the S wave

> 0.07 second

�N

O capture or fusionbeats

� Concordance leads willnot have the samepolarity

� Time required toreach either thepeak of R wave / thenadir of the S wave

< 0.07 second



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ECG Criteria� QRS complex in V1 has two positive

peaks R & R - Rabbit ears

� The relative heights of this ears

differentiate VT & SVT with aberrancy

� Tall R ± VT� Tall R - RBBB

1

1



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ventricular

aberrationventricular

tachycardia

rS

QS

Monophasic R

rsR 1 pattern

qRspatter



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MISCELLANEOUS

ELECTROCARDIOGRAM



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ELECTROCARDIOGRAM

³5´ steps approach to arrhythmias

Step2: Fix the regularity

Regular I I I I I I

Premature I I I I I I I

Escape I I I I I

IIrregular I I I I I I I I



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PREMATURE

COMPLEX ANY COMPLEX COMING BEFORE THE

NEXT EXPECTED PERIOD

WIDE N ARROW

(VENTRICULAR) (ATRIAL/JUNCTIONAL)



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ELECTROCARDIOGRAM



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ELECTROCARDIOGRAM



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ESCAPE COMPLEX

ANY COMPLEX COMING AFTER APAUSE

WIDE N ARROW

(VENTRICULAR)(ATRIAL/JUNCTIONAL)



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Arrythmia Recognition

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