Assessing Heart Rate ECG Basics - MedSchool

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Assessing Heart Rate


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On this page: Tachycardia Bradycardia

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The heart rate is the ventricular rate, or the rate of ventricular depolarisation.

Normal Range 60 - 100bpm

How to Measure Count the number of large squares between consecutive R waves (the R-R interval), and
divide 300 by that number.

Heart rate = 300 / no. of large squares between R waves

If the rhythm is irregular, the average R-R interval can be used to calculate the rate.

Tachycardia
A rapid ventricular rate of >100bpm may be in the context of a variety of rhythms that are clinically classified
as narrow complex tachycardias (QRS duration <120ms) and wide complex tachycardias (QRS duration
>120ms).

Tachyarrhythmias

Regular Narrow Complex Tachycardia

Sinus tachycardia

Focal atrial tachycardia

Atrial flutter

AV nodal reentrant tachycardia

AV reentrant tachycardia

Irregular Narrow Complex Tachycardia

Multifocal atrial tachycardia

Atrial fibrillation

Atrial flutter with variable block

Regular Wide Complex Tachycardia

Monomorphic ventricular tachycardia

SVT with aberrant conduction (bundle branch block)

SVT with preexcitation (accessory pathway)

Pacemaker-mediated tachycardia (atrial tracking or endless loop tachycardia)

Irregular Wide Complex Tachycardia

Polymorphic ventricular tachycardia

AF with aberrant conduction (bundle branch block)

AF with preexcitation (accessory pathway)

Other

Artefact - due to CPR, shivering, shaking or other movements

Bradycardia
A slowed ventricular rate of <60bpm (or <50bpm during sleep) may generally be caused by sinus node
dysfunction, atrioventricular block or escape rhythms in the setting of either of the above.

Bradyarrhythmias

Regular

Sinus bradycardia

Sinus arrest with escape rhythm

Complete heart block with escape rhythm

Irregular

Sinus arrhythmia

Sinus arrest

Second or third degree sinoatrial exit block

Atrial fibrillation with slow ventricular rate

Atrial flutter with variable block

Second or third degree AV block

Causes of Bradycardia

Intrinsic (SA or AV Nodal)

Idiopathic degeneration

Myocardial infarction

Congenital - congenital heart disease, neonatal lupus

Infiltrative disease - sarcoidosis, amyloidosis, haemochromatosis

Connective tissue disease - SLE, scleroderma, RA

Cardiac procedures - valvular surgery, correction of congenital heart disease, catheter ablation

Infections - Lyme disease, endocarditis, viral myocarditis

Extrinsic

Physiologic - sleep, athletes

Autonomic - neurocardiogenic syncope, carotid sinus massage, carotid sinus hypersensitivity

Drugs - beta blockers, calcium channel blockers, digoxin, adenosine, amiodarone, ivabradine, clonidine,
acetylcholinesterase inhibitors

Hypothyroidism

Hypothermia

Hyperkalaemia

Obstructive sleep apnoea

Raised intracranial pressure

Next up: Assessing Cardiac Rhythm

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