SHM's Clinical Quick Talks-Cardiac Arrhythmia

Pdf Summary

The document titled "Arrhythmia" by Francis Wright, MD, and Jeffrey Wagner, MD, outlines a comprehensive approach to assessing and diagnosing arrhythmias, focusing on tachyarrhythmias (heart rate over 100 bpm) and bradycardia (heart rate under 60 bpm). The key learning points emphasize identifying tissue perfusion as a primary step, understanding differential diagnoses based on QRS duration and R-R intervals, and using a systematic approach to bradycardia.<br /><br />For tachyarrhythmias, the document details classifications based on QRS complex width and regularity of the R-R interval. Narrow QRS (less than 120 ms) with a regular R-R interval suggests conditions like sinus tachycardia or supraventricular tachycardia (SVT), and changes observed in telemetry trends help differentiate these. Narrow and irregular R-R intervals indicate atrial fibrillation or multifocal atrial tachycardia, while wide QRS complexes suggest conditions like monomorphic ventricular tachycardia, requiring use of the Brugada criteria for differentiation.<br /><br />Bradycardia assessment also involves QRS and R-R interval analysis. For narrow QRS with regular intervals, sinus bradycardia or AV block scenarios are common, while irregular intervals suggest conditions like sinus arrhythmia or sinoatrial exit block. Wide QRS complexes can indicate more severe blocks, including Mobitz II AV block with random QRS drops.<br /><br />Clinical pearls highlight the importance of QRS duration and rhythm regularity in diagnosing tachyarrhythmias and caution about hypertension arising as a compensatory mechanism in bradyarrhythmia, advising careful blood pressure management.<br /><br />High-value resources for further learning include articles from the New England Journal of Medicine on supraventricular tachycardia and the American Heart Association's Advanced Cardiovascular Life Support guidelines. The document serves as a guide whenever evaluating a patient suspected of having an arrhythmia, providing a structured diagnostic framework.

Asset Subtitle

Jeffery Wagner

Keywords

Arrhythmia

Tachyarrhythmias

Bradycardia

QRS complex

R-R interval

Sinus tachycardia

Supraventricular tachycardia

Atrial fibrillation

Ventricular tachycardia

AV block