R H Y TH M CH EAT SH E E T

Initial question answer additional question rhythm diagnosis

Is it sinusrhythm and heart rate Sinus rhythm

1 N Y
< 100/min ?
FIRST QUICK VIEW

Ventricular fibrillation

Can you recognize a “rhythm at Ventricular flutter

Is the rhythm normal and if not, what‘s the basic rhythm?

2 N Y
a glance“? Atrial flutter

Pacemaker

In case of rhythm switch go back and evaluate the second rhythm

QRS duration > 0.1 s Ventricular tachycardia
RAPID AND REGULAR

Atrial tachycardia with BBB

QRS duration ≤ 0.1 s Sinus tachycardia

3 Is the rhythm rapid & regular? N Y
Atrial tachycardia

Atrio-ventricular reentry tachycardia (AVRT)

AV nodal reentry tachycardia (AVNRT)

P preceding QRS? “Upper“ junctional rhythm

Are the P waves neg. in II, III
4 N Y
and aVF?
P following QRS? “Lower“ junctional rhythm

QRS totally irregular? Atrial fibrillation (AF)

ZOOM IN TO P WAVE

Are the P waves absent or

5 N Y
QRS regular? “Mid“junct.rhythm
doubtful?
AF + 3rd deg. AV block (AVB)

PR constant? 2nd deg. AVB Mobitz Type II

6
Is the rhythm replaced?

Are there too many P waves? N Y PR varying QRS regular 3rd deg. AV Block

PR varying QRS irreg. 2nd deg. AVB Mobitz Type I

7 Do you see a rhythm switch? N Y which ones?

preceding premature P? supraventricular premature beat (SPB)

8 Do you see premature beats? N Y
no preceding premature P? ventricular premature beat (VPB)
BASIC RHYTHM INTERRUPTED
Is the rhythm disturbed?

following ventricular
compensatory pause
premature beat?

after termination of TC? preautomatic pause

Do you see a remarkable “empty“ pause SA (sinoauricuar) block

9 N Y
pause?
containing premature P? supraventricular premature beat + AV block

terminated by a QRS with a

different shape than the rest escape beat

of the QRS complexes

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