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 Ventricular flutter

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

at a glance“? Atrial flutter

Pacemaker

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

QRS duration ≥ 0,12 s Ventricular tachycardia

Atrial tachycardia with BBB

Rapid and regular

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

5 N Y
QRS regular? “Mid” junctional rhythm
or 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 irregular 2nd deg. AVB Mobitz Type I

7 Do you see a rhythm switch? N Y Which rhythms are present?

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

“Empty” pause SA (sinoauricuar) block

9 Do you see a remarkable pause? N Y

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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