A&E Vinayaka Arrhythmia Recognition An Emergency View
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A&E Vinayaka
Arrhythmia Recognition An Emergency View
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Cardiac conduction
A&E(SRMC)
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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 ³QRS´ & Chaotic
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A&E VinayakaNo QRS & Flat line
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Wide QRS
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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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A&E(SRMC)
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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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A&E(SRMC)
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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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A&E VinayakaA&E(SRMC)
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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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A&E(SRMC)
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ELECTROCARDIOGRAM
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A&E(SRMC)
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ESCAPE COMPLEX
ANY COMPLEX COMING AFTER APAUSE
WIDE N ARROW
(VENTRICULAR)(ATRIAL/JUNCTIONAL)
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A&E(SRMC)