Approach to ECGs - Tachy/Bradyarrhythmias

Tachyarrhythmias - HR > 100

Wide

  (1) VT - DANGER

  (2) Sinus Tachy w/ BBB

  (3) SVT w/ abberancy - N B Afib + WPW - DANGER

  (4) Vfib/flutter - DANGER 

Narrow - Regular

   (1) Sinus tachycardia

   (2) Atrial flutter

   (3) SVTs - atrial/junctional tachy not from SA node

Narrow - Irregular

   (1) A fib -absent P

   (2) A flutter - w/ variable block

   (3) Multifocal atrial tachycardia (MAT)

     - 3 different P waves in lead II

     - treat with beta-agonist despite tachy

Bradyarrhythmias - HR < 60

  (1) Sinus bradycardia

  (2) Sick Sinus Syndrome (runs of tachy/brady)

  (3) SA node block - escaped beats

  (4) SA node arrest - escape rhythms

  (5) AV block

1º - long PR intervals >120-200ms from longer pause

2º - Mobitz I / Wenkebach - successively longer PR intervals (2:1 , 3:2, 4:3, etc.)

2º - Mobitz II / Mobitz - , 3:1, 4:1, etc. - DANGER

3º - P running through QRS - DANGER

Narrow QRS - Proximal AV block (lower AV cells can function)

Wide QRS - Distal AV block - ventricular pacemaker



- Dr. Michael Wong @mchlwng



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