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ECGs Made Easy Ch. 6

Ventricular Rhythms

QuestionAnswer
What is a Ventricular Beat or Rhythm? A rhythm that begins from an impulse created BELOW the AV Junction/Bundle of His, Can occur as a result of either: Re-entry, enhanced automaticity and triggered activity
What causes Ventricular Beats/Rhythms? Failure of the SA Node to discharge, Failure of an SA Node impulse to conduct through normal circuit, SA Node firing rate is slower than the Ventricular intrinsic rhythm, An irritable site in the Ventricles is firing faster than the SA Node.
What are the characteristics of a Ventricular Beat or Rhythm? The ventricles are not simultaneously stimulated resulting in: Abnormally shaped/long QRS complexes (>0.12 sec), Possible retrograde P waves, ST segment and T waves opposite in direction (deflection) of the QRS complexes
If the QRS complex is negative? The ST segment and T wave will be positive.
What is a Premature Ventricular Complex (PVC)? A beat from an impulse created in the ventricle earlier than NESB (SA Node impulse), Can very in morph depending on the origin (focus) of the impulse, Can occur single (isolated) in pairs (couplet) 3 or more (runs), Followed by compensatory pause
What causes a PVC? Can be of no particular cause in apparently healthy individuals, exercise, ACS, heart failure, stimulants, Ventricular aneurysm, increase in sympathetic tone, digitalis toxicity, other medications
R on T Phenomenon? Occurs when the R wave of a PVC lands on the T wave of the preceding beat , Ventricular repolarization is not yet complete, Strong possibility that this rhythm can precipitate Ventricular Tachycardia or Ventricular Fibrillation.
Interpolated PVCs? Occurs when a PVC occurs between two normally conducted QRS complexes, Does not have normal compensatory pause length, Does not disturb the next Ventricular depolarization or SA Node activity.
What is Ventricular Escape? Can occur when a rhythm or premature beat results in a delay or pause in conduction, The ventricular pacing is faster than the preceding pause, The beat itself looks like a PVC but it occurs after the next expected sinus beat (not premature), Compensatory
What is Idioventricular Rhythm? Term that is used for a SLOW ventricular rhythm (rate:20-40bpm), Does not qualify as an Idioventricular rhythm if you can see transition or escape.
What is Accelerated Idioventricular Rhythm? Term that is used for a SLOW ventricular rhythm but faster than a Idioventricular Rhythm (rate:41-100 bpm), Should not be used if you can see transition or escape
What causes Accelerated Idioventricular Rhythm (AIVR)? Acute Myocarditis, Cocaine Toxicity, Digitalis Toxicity, Dilated CMY, HTN with CHD and Subarachnoid hemorrhage
What is Agonal Rhythm? Ventricular Rhythm with a rate less than 20 bpm, Often referred to as a "dying heart"
What is Ventricular Tachycardia? 3 or more ventricular beats (PVCs) occur at a rate of >100 bpm, High risk precursor for Ventricular Fibrillation
Recognizing V Tach on an EKG: Monomorphic V Tach Occurs from a single focus, Beats will look similar in size, shape, and amplitude
Recognizing V Tach on an EKG: Polymorphic V Tach Occurs from more than one focus, Beats will VARY in size, shape, and amplitude, Torsades de Pointes
What is Torsades be Pointes? Polymorphic V Tach that occurs in the presence of a long QT interval
What is Ventricular Fibrillation? Chaotic rhythm with rates typically indiscernible (or noted as 350+bpm), No "organized" depolarization of the ventricles
Recognizing V-Fib on an EKG: Low amplitude EKG (typically 3mm or less), Irregular chaotic rate, May be coarse or fine
What is Asystole? The absence of electrical activity
What does a narrow QRS mean? Rapid activation of the ventricles from the normal Bundle of His/Purkinje Fibers system, the arrhythmia originated above or within the Bundle of His
The QRS of a PVC is how many seconds? >0.12 seconds
What is the normal QRS duration? 0.08 - 0.12 seconds
What is Unifocal (PVC)? (Similar in appearance and come from the same focal point (site)) The same morphology and same coupling interval in a given lead
What is Multifocal (PVC)? (Different in appearance and come from different focal points (sites)) Different morphology and coupling interval in a given lead
What is a PVC Couplet? Two PVCs on the same lead that have the same R-R Interval back to back
What is a PVC Run? Three or more PVCs on the same lead that have the same R-R Intervals back to back
What is a PVC Trigeminy? Every 3rd beat is a PVC on the lead
What is PVC Bigeminy? Every other beat is a PVC on a lead
What are Uniform PVCs? PVCs that look alike in the same lead and begin from the same anatomic site
What is a Multiform PVC? PVCs that look different from one another in the same lead
Are Uniform PVCs Unifocal? Yes. Uniform PVCs are Unifocal, they arise from the same anatomic site within the ventricles
Are Multiform PVCs Multifocal? Most of the time but not necessarily. Multiform PVCs often arise from different foci but not always
How to know it is a PVC? The QRS Complex is premature (it occurs before the next expected sinus beat), QRS of PVC is >0.12, Sinus rhythm is not disrupted, The relationship between the previous beat and PVC (coupling interval) is the same for each morphology of PVC
Ventricular Tachycardia: Regular or Irregular? (Broad complex Tachycardia) Regular
Ventricular Fibrillation: Regular or Irregular? (Broad complex Tachycardia) Irregular
Polymorphic Ventricular Tachycardia: Regular or Irregular? (Broad complex Tachycardia) Irregular
Torsades de Pointes: Regular or Irregular? (Broad complex Tachycardia) Irregular
Ventricular Escape Rhythm: P waves present? Narrow or Broad QRS? P waves absent, Broad QRS
Created by: kdanie24
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