Ventricular Dysrhythmias

A pattern of PVC in which every other complex is a PVC

Bigeminy

a pattern of PVCs in which every 3rd complex is a PVC

Trigeminy

every 4th complex is a PVC

Quadgeminy

Two PVCs that occur back to back

Coupling

Six or more PVCs per minute

Frequent PVCs

PVC that occurs during the normal R-R Interval without interrupting the underlying rhythm

Interpolated PVC

Varied shapes and forms of the PVCs, suggesting more than one irritable focus

Multifocal PVC

Less than 6 PVCs per minute

Occasional PVC

A witnessed change in any cardiac rhythm, including starting, stopping or both; for ex- sinus rhythm to SVT or Ventricular Tach to Ventricular fibrillation

Paroxysmal Event

An ectopic impulse originating in either ventricle that occurs too early in the cycle

Premature Ventricular Complex (PVC)

PVC that occurs on the downslope of the T wave or the vulnerable period of the relative ventricular refractory period

R on T PVC

Three or more PVCs occuring in a row at a rate greater than 100bpm

Run of Ventricular Tachycardia or Salvo or Triplet PVC

Early Complexes that have a similar shape, suggesting only one irritable focus present

Unifocal PVC

Depolarization impulses move from one ventricle to the other; occurs due to electrolyte deficiencies; treatment includes magnesium sulfate

Rhythm: P-P interval usually not identifiable; R-R interval usually regular, can be slightly irregular at times.

Rate: Ventricular rate- 100‒200 beats per minute; Atrial rate- Cannot be determined

P wave: Absent

PR interval: Cannot be determined

QRS: Duration greater than 0.12 second; Wide, bizarre appearance; T wave in opposite direction (usually down) from QRS complex

Lost atrial kick and decreased ventricular filling time result in decreased cardiac output.

Approximately 50% of patients become unconscious immediately.

Notify licensed practitioner immediately.

Save rhythm strips in medical record to document rhythm changes.

Torsades De Pointes (SVT or VT)

Occurs when all the pacemakers of the heart have failed; the heart is dying; ventricular rate is less than 20bpm

Rhythm: There is no P-P interval; R-R may or may not be regular

Rate: Ventricular- Less than 20bpm; Atrial- cannot be determined

P wave: No P wave is present

QRS: 0.12 secs or greater; wide, bizarre appearance

Profound loss of cardiac output.

Patient will be unconscious.

Notify health care practitioner immediately.

This is a medical emergency; BLS and ACLS interventions will be initiated.

ECG strips must be saved and put in medical record.

**Medical Emergency**

Agonal Rhythm

Impulse created by the ventricular pacemaker; SA node & junctional Pacemaker failed to initiate impulse; presents with classic QRS, slow ventricular rate; & no P waves; 20-40bpm

Rhythm: R-R interval is regular; P-P interval cannot be determined

Rate: Ventricular- 20-40bpm; Atrial- Cannot be determined

P wave morphology: No P wave is present.

PR interval: Cannot be measured

QRS duration and morphology: 0.12 seconds or greater; Wide, bizarre appearance

**This is a medical Emergency**

Profound loss of cardiac output

The patient will likely be unconscious.

Notify health care practitioner immediately.

This is a medical emergency.

Likely to require medication and/or pacing.

ECG strips must be saved and put in medical record.

Idioventricular Rhythm

impulse created by the ventricular pacemaker due to SA and AV node failure; QRS is wide & bizarre; P waves are absent; 40-100bpm

Rhythm: R-R interval is regular; P-P interval cannot be determined

Rate: Ventricular- 40‒100 bpm; Atrial- Cannot be determined

P wave: No P wave is present

PR Interval: Cannot be identified

QRS: 0.12 second or greater; Wide, bizarre appearance

Decrease in cardiac output due to slow ventricular rate and loss of atrial kick.

Patient may be unconscious.

Notify health care practitioner immediately.

May require medication and/or pacing.

ECG strips must be saved and put in medical record.

Accelerated Idioventricular Rhythm

Occurs when there is 3 or more PVCs in a row & the HR is over 100bpm; Ventricles are continously contracting & relaxing with no period of repolarization.

Rhythm: P-P interval usually not identifiable; R-R interval usually regular, can be slightly irregular at times.

Rate: Ventricular rate- 100‒200 beats per minute; Atrial rate- Cannot be determined

P wave: Absent

PR interval: Cannot be determined

QRS: Duration greater than 0.12 second; Wide, bizarre appearance; T wave in opposite direction (usually down) from QRS complex

Lost atrial kick and decreased ventricular filling time result in decreased cardiac output.

Approximately 50% of patients become unconscious immediately.

Notify licensed practitioner immediately.

Save rhythm strips in medical record to document rhythm changes.

ventricular Tachycardia

chaotic, asynchronous electrical activity within ventricular tissue; Ventricle walls quiver, preventing ejection of blood; No cardiac output

Rhythm: P-P and R-R intervals cannot be determined because neither P waves nor R waves are present.

Rate: Neither the atrial nor the ventricular rate can be determined.

P wave morphology: No P waves are present.

PR interval: There is no PR interval.

QRS duration and morphology: Cannot be determined.

Always check the patient first.

In true *Rhythm name* : ***Medical Emergency***

Patient is unconscious, apneic, and pulseless

True emergency situation

Initiate Code Blue and begin CPR/ACLS procedures immediately.

Ventricular Fibrillation

Absence of ventricular activity and depolarization; no electrical activity is present in the myocardium; straight line/ flatline; Always confirm waveform in at least two different leads to rule out “fine” ventricular fibrillation.

Rhythm: No waveforms are present.

Rate: No atrial or ventricular rates are present.

P wave morphology: No P waves are present.

PR interval: Cannot be measured

QRS duration and morphology: Not measurable

Situation is life-threatening.

Patient will be unconsciousness and apneic.

Patient is in cardiac arrest; initiate emergency procedures.

Always a Code Blue situation.

Asystole