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1
Ventricular Arrhytmia
Supraventricular Ventricular
Narrow Complex QRS Wide Complex QRS> 0,12 dt
(except: BBB, WPW,aberans)
Ventricular arrhythmias
Triggered beats
○ Afterdepolarizations (AD): Abnormal depolarizations of myocytes that
interrupt phase 2, 3, or 4 of the AP
Re-entry
○ Creation of a circuit that leads to 2 or more depolarizations in
surrounding tissue
Afterdepolarization
Epidemiology
Very common; occur in healthy people & pts
with cardiac disease
Etiology
Cardiac: CAD, post-MI, MVP, CHF, rheumatic
heart disease, congenital arrhythmias
Non-cardiac: acid-base disturbance, electrolyte
abnormalities, meds, caffeine, anxiety
Symptoms
Palpitations, “skipped beats”
Chest or neck discomfort
SR SR
SR SR SR SR
Trigeminy
PVC every 3rd beat
Couplets
Two successive PVCs
Triplets
Tree successive PVCs
Rate <100bpm
Ventricular Tachycardia (VT)
Life threatening arrhythmia
May lead to VF and sudden death
Etiologies
Heart disease (prior MI, CAD, CM, valvular)
ECG findings
≥3 consecutive PVCs with a rate of 100-250 bpm
No P waves
QRS axis -30° to -180°
AV dissociation
Fusion beats and captured beats
Duration
○ Non-sustained: <30sec
○ Sustained: >30 sec or requiring termination because of hemodynamic
collapse
Ventricular Tachycardia
Monomorphic VT
Polymorphic VT
Torsades de Pointes
Sinus bradycardia
AIVR
May result from accelerated ventricular focus that is faster than the
prevailing sinus rate
rd
and takes over or can occur as escape rhythm (
generally with 3 degree AVN block)
Usually 60-100 bpm (differentiates from VT)
Regular wide QRS
Associated with post-MI (especially inferior wall MI), reperfusion tx, digoxin
toxicity, or after a PVC
Usually self limited, rarely see progression to VT/VF
Take home points
PVCs are very common arrhythmias that can occur in healthy or
diseased hearts with multiple features on ECG