ventricular arrhythmias Flashcards by Bethany Eaton

premature ventricular contraction

premature firing of a ventricular cell

initiated by purkinje fibers
causes ventricles to be in a refractory state-so when the normal pacers fire, the ventricles won’t contract at the normal time

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what is a compensatory pause>

pause- pause in the heart beat following an extrasystole that is long enough to compensate for the prematurity of the extrasystole

*seen in PVC so the next beat will arrive on time

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what are some features of PVCs

Often benign
Frequent PVCs can depress ventricular function
Precursor to ischemia or structural disease
Substantial day to day variation
Affected by stress, medications, caffeine

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sx of PVC

palpitations, dizzy, strong Heart beat, pause

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what is something to look for during a stress test? (what happens to PVC?)

want PVC to go away- if they increase it may indicate ischemia

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EKG findings on a PVC

Rate: Depends on underlying rhythm

Rhythm: Irregular
P wave: Not present on PVC

P:QRS ratio: No P waves on the PVC

PR interval: None
QRS: Wide >0.12 seconds

Grouping: Bigeminy, Trigeminy possible

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classifying PVC: 1?

PVC

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classifying PCV: 2 in a row?

couplet

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classifing PCS: 3 + in a row but lasting less than 30 sec

nonsustained ventricular tachycardia (Vtach)

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patter of PVCs: every other beat?

bigeminy

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pattern of PVCs: every 3rd beat

trigeminy

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ventricular escape beate

occurs when SA node fails to fire and next available pacemaker cell is in the ventricle

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what happens to the normal rhythm in a ventricular escape beat?

origianl pacemaker doesn’t fire, so the next beat doesn’t arrive on time

*noncompensatory pause

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sx of ventricular escape beat

paplitations, dizzy, presycope, syncope

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tx of ventricular escape beat?

electrolye corrections, pacemaker if become rhythm

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EKG findings in ventricular escape beat

Rate: Depends on underlying rhythm
Rhythm: Irregular

P wave: Not present on PVC

P:QRS ration: No P waves on the PVC

PR interval: None

QRS: Wide >0.12 seconds
Grouping: None

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Idioventricular rhythm

occurs when ventricular foci act as primary pacemakre for the heart

(20-40 bpms)

*can also have accelerated idoventricular rhythm (40-100 bpm)

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sx of idioventricular rhythm

dzzy, pre-syncope, syncope

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tx of idioventricular rhythm

underlying causes,

BB with CAD

atrial overdrive pacemkater

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EKG finding ins idioventriculare rhythm

Rate: 20-40 or 40-100
Rhythm: Regular
P wave: None
P:QRS ration: None
PR interval: None 
QRS: Wide >0.12 seconds

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ventricular tachycardia

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very fast ventricular rate that is dissocaited from underlying atrial rate

*no marriage of P and QRS

nonsustained VT?

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Runs of three or more ventricular beats lasting <30 seconds and terminating spontaneously

Increased mortality (SCD) in patient’s with heart disease

sustained VT?

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Ventricular beats lasting >30 seconds, intervention often required to terminate

High risk of reoccurrence
With LV dysfunction SCD high

monomorphic VT

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The appearance of all the beats match each other in each lead (same QRS configuration)

Can deteriorate to VF

BAD NEWS

POLYMOrphic VT

Beat to beat variations is morphology Torsades de pointes- polymorphic VT in the context of prolonged QT interval Think ischemia

sx of VT

NST asx palpitations, CP, SOB, presyncope, syncope, hemodymaiclly compromised

tx of vtach (if NSVT or premature beats)

BB or CCB if pt is symptomatic

tx of VTach if pt has hypotension, loss of consiousness,

synchronized cardioversion

pulseless vtach tx?

immediate defibrillation along with CPR

acute Vtach pharmacological tx

amiodarone lidocaine procainamide

what is brugadad syndrome?

genetic disorder that causes syncope, ventricular fibrillation and sudden death, often during sleep

torsades de pointes

Occurs with underlying prolonged QT interval: Congenital Drugs Electrolyte imbalances Can convert to a normal or ventricular rhythm QRS morphology twist around baseline like a party streamer Very serious: Harbinger for death, Ventricular Fibrillation

tx of torsades

Treatment: IV Magnesium, Potassium, Defibrillation

ventricular flutter

very fast vtach - can no longer tell QRS, Twave, ST segments - sinosoidal pattern tx same as V tach

ventricular fibrillation

cardiac chaos | different ares of ventricles firing all at their own pace w/ no coordination or organization

what is the main cause of sudden cardiac death?

vfib

causes of v fib

myocardial infraction hypokalemia drug toxicity

tx of v fib

nonsynchronized defibrilattion; biphasic 120-200 J (don't have to synch bc there is nothing tto synch up with) amiodarone for 24-48 hours

pulseless electrical activity

can be any rhythms at all w/o a pulse CPR

AV blocks

Delay or interruption in the transmission of an impulse from the atria to the ventricles Conduction blocks between sinus node and purkinje fibers Occurs at AV node, Bundle of His and below Key determining factor is the PR interval

first degree heart block

prolonged block in the AV node, ery impulse is conducted

what can cause a first degree heart block

meds, vagal stimulation, dz,

what will the PR interval look like?

>.20 sc

first degree sx

asx dizzy, presyncope, syncope

tx of first degree

reverse cause, nothing, pacemaker

Mobitz I second degree

Wenckenback Caused by a diseased AV node with a long refractory period Progressive delay between atrial and ventricular contraction and the eventual failure of a QRS following a P wave (dropped beat)

causes of Mobitz I

Normal in individuals with high vagal tone (young, athlete) Heart disease- RCA, inferior MI Post mitral valve surgery Lyme disease

Mobitz 1 sx

asx, bradycardia palpiations

tx of mobitz 1

unstable: atropine,pacing stable: pacing pads in lace, revascularization, remove toxin

EGK Mobitz 1

PR interval gets larger and larger until the bieat drops

Mobtiz II

Occurs due to a diseased AV node Block usually occurs in the Bundle of His May lead to complete heart block Distinguishing factor: presence of non-conducted beat without progressive lengthening of PR interval, **pt can have bothe a I and II degree block-can be in different places

what is a third degree heart block

Complete block of the AV node Atria and Ventricles are firing separately each to its own drum 2 pacemaker sites, atrial 60-100 bpm and ventricles 30-50 bpm, both will be regular but independent Medical emergency, typically requires a pacemaker

ventricular arrhythmias Flashcards

(52 cards)