Yan Yu, 2012 (www.yanyu.

ca)
Is QRS normal or wide?
P-waves: present? Shape? Rate?
Relationship btw P-waves + QRS?
Response to vagal maneuvers?
Diagnostic Approach to Arrhythmias
(abnormal cardiac rate and rhythm on ECG or Cardiac Monitor)
Are P-waves present?
Relationship btw P-waves
and QRS?
Tachy-arrhythmias (>100bpm) Brady-arrhythmias (<60 bpm)

Regular Rhythm Irregular Rhythm

Wide QRS on ECG (>120ms) Narrow QRS on ECG (<120ms)
(slow ventricular depolarization) (fast ventricular depolarization) A/V
Normal Sinus
Rhythm dissociation
Sinus Bradycardia 3rd deg AV Missed QRS Sinus pauses,
Ventricular Tachy (VT) SVT with conduction (can be normal) block after P-waves chonotropic
Hx of MI (esp Anterior STEMIs): re- delay (“abherrancy”) Supra-ventricular 2nd deg AV incompetence
entrant circuit around ventricular scar (responds to/stops with Tachy (SVT) No P-waves PR interval > block Sick Sinus
Hx of other structural heart diseases: vagal maneuvers; Escape rhythms due 200ms Syndrome
Sudden-onset, constant
HF, ventricular hypertrophy, valve QRS morphology constant to SA block/arrest 1st deg AV Tachy-Brady
palpitations
disease, congenital abnormality regardless of heart rate) ECG: P-waves abnormal (Junctional, Idio- block syndrome (w/ A-
Hx of Long-QT syndromes (genetic, SVT w/ BBB Ventricular) fib/A-flutter)
potassium imbalance, etc) R/o A-fib if irregular Atrial Fibrillation (Afib)
ECG: P-waves unrelated to QRS Antidromic AVRT No distinct P-waves, chaotic baseline (not isoelectric)
complexes, V1-V6 concordance of QRS (ventricular contractions via Caused by ectopic foci near pulmonary veins
complexes (all deflecting + or – ) accessory path only)
Sustained VT = dangerous! Could lead (Tx Wide-complex tachy Multifical Atrial Tachycardia (MAT)
Regular Rhythm Irregular 3+ P-wave shapes; isoelectric baseline btw P-waves
to 0 cardiac output as VT until proven
otherwise) (constant P-P interval) Rhythm Caused by severe pulmonary disease/hypoxemia
Atrial Flutter w/ variable block
Monomorphic VT Polymorphic VT
Multiple ectopic foci
Ventricular Fibrillation (VF) Atrial rate P-wave morphology Carotid Sinus Massage
Lone re-entry circuit
or changing re-entry Triggered by V-tach in a pt w/ (bpm) response (↑ vagal tone)
around single scar
ECG: Capture + circuits Serious underlying heart dx
fusion beats, AV
Long QT predisposes 0 cardiac output, fatal! Sinus Tachy 100-180 Can be normal Atrial rate may ↓
R-on-T events (i.e.
dissociation Tx: immediate defibrillation!
torsades de pointes)
Anti-arrhythmics (prevent Re-entrant SVTs 140-250 Hidden in QRS, or May abruptly stop
(AVRT, AVNRT) (paroxysmal) retrograde
recurrence); ICD (Long-term; only
Treatment of VT: tx that ↓ mortality) Focal Atrial 130-250 Different shape, due to Doesn’t usually stop tachy
If unstable: electric cardioversion Tachycardia (paroxysmal) ectopic pacemaker AV block may ↑
If stable: anti-arrhythmic drugs
LT: implanted cardiac defibrillator Atrial Flutter 180-350 “saw-toothed” AV block may ↑