窄QRS波心动过速鉴别诊断

窄QRS波心动过速鉴别诊断

DifferentialdiagnosisofnarrowQRScomplextachycardiaRate&RhythmAxis&voltageIntervalMorphologyIschemiaACC／AHA／HRS成人室上速处理2015指南起源于希氏束或希氏束以上，静息心率超过100bpm的心律称为室上速房扑房颤房速窦速JTAVNRTSVTAVRT不良性窦速不典型房扑多源性房速阵发性JTRegularlyregular01Irregularlyregular02Regularlyirregular03Irregularlyirregular

A-fib04fwaveCoarsefwaveA-fibwithprematurecomplexA-fibwithAVBM/60presentswithasthmaexacerbationIrregularlyirregular:Afib?AFib

Aflutterwithvariantconduction

Mutifocalatrialtachycardia

Irregularlyirregular:Afib?AFibNoclearregularatrialactivtyAflutterwithvariantconductionRegularatrialactivity,rate~300MutifocalatrialtachycardiaClearatrialactivitybutirregularAflutterwithvariantconductionRhythm?M/65withalteredMS;SBP75Irregularlyirregular:Afib?AFibNoclearregularatrialactivtyAflutterwithvariantconductionRegularatrialactivity(Fwaves),rate~300MutifocalatrialtachycardiaClearatrialactivitybutirregularwith≥3differentmorphologiesM/65withalteredMS;SBP75MATMostoftenassociatedwithpulmonarydisease(acuteorchronic),hypoxiaContributingfactorsBBsTheophyllineHypoMg,hypoKOftenassociatedwithorleadstoAfiborAflutterMATInitself,isnotadestabilizingrhythmPredictspoorPxinpatientswithinfection,respfailure,CHFMAT NodominantatrialfocusIrregularlyirregularrhythmAtleast3morphologicallydistinctPsVariablePP,PR,andRRSomePsmaybenon-conductedAberrantconductionmaybepresentedRatecanbe90-250(usually100-150)MATtreatmentCardioversiondoesn’thelpTreatunderlyingrespiratoryproblem,butMATmaypersistfordaysCorrectlytesEmpiricmagnesium?Verapamil?MATMATRegularlyregular01Irregularlyregular02Regularlyirregular03Irregularlyirregular

A-fibMATAflutterwithvariantconduction04F/75presentswithpalpitationRegularlyregularSinustachycardiaPSVTAflutterwith2:1conductionRetrogradePwaveSVTtreatmentVagalmaneuvers→successfulin20-25%Adenosine→successfulin90%CCBBeta-blockers(don’tcombinewithCCBs)TypeIamedications(rarelyused)Cardioversion(startat50J)EvaluateforunderlyingcauseDrugsThyroiddisordersElectrolytedisordersHypoxiaPEetcSVTasanisolatedmanifestationofACS?AfterconversionSVTasanisolatedmanifestationofACS?Veryrare;routineruleoutMIunnecessaryTroponinsproducefalsepositivesST-depressioncauseforconcernClinicalsignificanceisunknownOnlycauseforconcernifST-depressionpersistsafterconversionYoungW28wkspregRegularlyregularSinustachycardiaonePwavewitheveryQRSSVTPsmaybehiddenormayfollowtheQRScomlpexAflutterwith2:1conduction2atrialbeatsforeveryQRScomplexusuallyseesawtoothpatternofatrialbeatsatrialactivityisoftenobviousinonly1or2leadsExactdiagnosisisrarelyneededintheED,asTxprotocolisgenerallyeffectiveforalltypes房扑房颤房速窦速JTAVNRTSVTAVRTSinustachycardiaA-flutterwith2:1conductionFwaveinIIIIIaVFFwaveinV1ValsalvaAflutterwithAVBSVTElectricalternansAfterconversionRegularlyregular

STSVTA-flutter01Irregularlyregular02Regularlyirregular03Irregularlyirregular

A-fibMATAflutterwithvariantconduction04M/67withESRDpresentswithfevers,bacteremia,historyofAFibClumpsorgroupedbeatsRegularlyirregularrhythms:NOTAFibPACsMobitzBetterbaselineMobitzIorIIMobitzIwith3:2conductionF/80sentforrapidafibIrregularlyirregular?Irregularlyirregular?Clumps!NotirregirregClumps!NotirregirregMobitzIMobitzIIF/73withcoughandwheezingPACs:AtrialTrigeminyAfib?STwithMobitzIJunctionalTrigeminyAtrialBigeminySinusRhythm,thenJunctionalBigeminyRegularlyirregularAfibisoftenoverdiagnosed–don`ttrustyourcomputerAfibshouldproduceanirregularlyirregularventricularresponseClumps=2nddegreeAVblock;MobitzIorIIorPrematurecontractions;bigeminyortregeminyRegularlyregular

STSVTA-flutter01Irregularlyregular02Regularlyirregular

PACsMobitzIorII03Irregularlyirregular

A-fibMATAflutterwithvariantconduction04房扑房颤房速窦速JTAVNRTSVTAVRT不良性窦速不典型房扑多源性房速阵发性JTAtrialtachyca