Chapter 6 - Ventricular Rhythms

What does PVCs stand for?

Premature Ventricular Complexes

What are PVCs?

When an irritable focus within the ventricle delivers an impulse

What are the characteristics of PVCs?

Rhythm: Irregular
Rate: 60 - 100 BPM
P wave: Usually absent
PR Interval: None
QRS: 0.12 sec or greater

What causes PVCs?

• Exercise

• Medications

• Acid-base imbalance

What is done about PVCs?

Generally we don’t do nothing

FILL: PVCs have a full ____________ pulse

Compensatory

TRUE or FALSE: PVCs are late with wide QRS

FALSE: PVCs are early

What is Ventricular Escape Beat?

A beat that occurs after a pause in which a supraventricular pacemaker failed to fire

What are the characteristics of Ventricular Escape Beat?

Rhythm: Irregular
Rate: 60 - 100 BPM
P wave: Absent
PR Interval: None
QRS: 0.12 sec or more

What causes Ventricular Rhythmb?

Cardiac Standstill

What is done about Ventricular Escape Beat

Generally nothing

What does IVR stand for?

Idioventricular Rhythm

What are Idioventricular Rhythms?

Three or more ventricular escape beats in a row

What are the characteristics of Idioventricular Rhythm?

Rhythm: Regular
Rate: 20 - 40 BPM
P wave: None
PR Interval: None
QRS: 0.12 sec or more

What causes Idioventricular Rhythm?

Anything that causes the SA node and AV junction to not reach the Purkinje fibers

What is done about Idioventricular Rhythm?

If signs and symptoms:

• Apply a pulse oximeter

• Administer supplemental oxygen

• Establish IV access

• Obtain a 12-lead ECG

• Administer IV atropine

What is Monomorphic VT?

Three or more ventricular beats in a row; the QRS complexes are of the similar shape and amplitude

What is Accelerated Idioventricular Rhythm

When three or more ventricular beats happen in row

What are the characteristics of Accelerated Idioventricular Rhythm?

Rhythm: Regular
Rate: 41 - 100 BPM
P waves: Usually none
PR Interval: None
QRS: 0.12 or more

What does AiVR mean?

Accelerated Idioventricular Rhythm

What causes AiVR?

• Generally seen right after an acute MI (first 12 hours)

• Cardiac arrest

• Coronary artery procedures

What is done about AiVR?

• Treatment usually unnecessary

• Symptomatic

  • Apply a pulse oximeter

  • Administer supplemental oxygen

  • Establish vascular access

  • Obtain 12-lead ECG

  • Atropine

What are the characteristics of Monomorphic VT?

Rhythm: Regular
Rate: 101 - 250 BPM
P wave: None
PR Interval: None
QRS: 0.12 sec or more

What causes Monomorphic VT?

• Structural Heart Disease

• Trauma

• Acute coronary syndromes

What is done about Monomorphic VT if pulseless?

• CPR

• Defibrillation

What is done about Monomorphic VT if a stable pulse is present?

• Oxygen

• IV access

• Ventricular antiarrhythmics

What is done about Monomorphic VT if an unstable pulse is present?

• Oxygen

• Synchronized cardioversion

What is Polymorphic VT?

Three or more PVCs in a row at a rate of 150 - 250 where the shape and amplitude will very

What does PMVT mean?

Polymorphic VT

What are the characteristics of Polymorphic VT?

Rhythm: Ventricular rhythm may be regular or irregular
Rate: 150 to 300 beats/min
P waves: None
PR Interval: None
QRS: 0.12 sec or greater

What cause Polymorphic VT?

• Catecholamines

• Ischemia

• Idiopathy

PMVT occurs when someone has a _____ QT.

Short; also called short-QTPMVT

What type of PMVT occurs when the QT interval is long?

Torsades de Pointes

What is TdP?

Torsades de Pointes

What is done about PMVT?

• Seek expert consultation

• Treatment will vary depending on the cause

What is Ventricular Fibrillation?

A chaotic rhythm that begins in the ventricles

What does Vfib mean?

Ventricular Fibrillation

What are the characteristics of Vfib?

Rhythm: Rapid and chaotic
Rate: Cannot be determined
P wave: Not discernible
PR Interval: Not discernible
QRS: Not discernible

What causes Vfib?

• Electrocution

• Severe heart failure

• Hypertrophy

• Structural heart disease

What is done about Vfib?

• CPR

• Defibrillation

• Use H’s and T’s

• Administer medication

What are the two types of Vfib?

Coarse and Fine

What does coarse Vfib look like?

Bumpy waves

What does fine Vfib?

Shaky waves

FILL: Vfib is when the ventricular myocardium _______?

Quivers

What is Asystole?

Total absence of atrial and ventricular electrical activity

What are the characteristics of Asystole?

Rhythm: Ventricular not discernible; atrial may be discernible
Rate: Ventricular not discernible, but atrial activity may be seen
P wave: Not always present
PR Interval: None
QRS: None

What causes Asystole?

• Shocking

• Defibrillation

• Medications

• Synchronized cardioversion

FILL: After a shock, there will be a brief period of ________

Asystole

What is done about Asystole?

• Confirm that the patient is unresponsive and has no pause

• CPR

• Establish IV access

• Try to reverse the causes

• Administer medications

What are your five H’s?

• Hypovolemia

• Hypoxia

• H+ ion acidosis

• Hyper/Hypo (kalemia)

• Hypothermia

What are your five T’s?

• Tension pneumothorax

• Cardiac tamponade

• Toxins

• Coronary Thrombosis

• Pulmonary Thrombosis

What is Agneal ventricular rhythm?

Less than 20