Ventricular Dysrrhythmias

1
Ventricular Dysrrhythmias

• EMS Technology
• Temple College

2
Topics for Discussion

• Premature Ventricular Complexes (PVCs)
• Idioventricular Rhythm (IVR)
• Ventricular Tachycardia (VT)
• Ventricular Fibrillation (VF)
• Asystole
• Ventricular Paced Rhythm

3
Premature Ventricular Complexes (PVCs)

• Early depolarization of the ventricles
• Occur as a result of
• Automaticity
• Reentry

• Terms to Know
• Compensatory Pause
• Automaticity
• Reentry
• Ectopic / Escape Beat

4
Premature Ventricular Complexes - Characteristics

• Complex is early
• Wide QRS, gt0.12 seconds
• Often has a compensatory pause

• Usually
• rhythm is irregular
• not preceded by P wave
• T wave opposite deflection

5
Premature Ventricular Complexes - Characteristics

• More Terms to Know
• Unifocal, Multifocal
• R on T Phenomenon
• Couplet
• Run of PVCs
• Bigeminy, Trigeminy, Quadrigeminy

• Considerations
• Wide is not always ventricular
• May or may not perfuse
• Identify the underlying rhythm first

6
Idioventricular (IVR) Rhythm

• Ventricular focus takes over as escape rhythm
• Result of non-functioning, higher pacemaker sites

• Characteristics
• Wide QRS, gt 0.12 seconds
• Usually regular until slows
• No P waves
• typical rate 20 - 40 bpm

7
Idioventricular (IVR) Rhythm

• Considerations
• No cardiac output
• Late and often terminal rhythm
• Non-resuscitation results in Asystole

8
Ventricular Tachycardia (VT)

• Irritable ventricular focus takes over as
  pacemaker
• May result from multiple foci attempting to pace

• Various versions exist
• Monomorphic
• Polymorphic
• Torsades de Pointes
• Slow VT

9
Ventricular Tachycardia - Characteristics

• Complexes look similar to PVCs
• Wide QRS, gt0.12 seconds
• May see P waves before complexes but uncommon

• Usually
• Regular
• rate between 100 - 250 bpm
• complexes look similar to each other
• Canon a waves may be seen at EJ

10
Ventricular Tachycardia - Characteristics

• Considerations
• May or may not produce adequate cardiac output
• Non-perfusing VT quickly becomes VF

• Torsades de Pointes
• Twisting of the points
• Polymorphic
• Usually gt 200 bpm
• Susceptible if slow repolarization (long QT)

11
Ventricular Fibrillation (VF)

• Sudden cardiac death (Primary VF)
• Secondary to other cause (Secondary VF)
• Multiple ventricular foci depolarizing
  asynchronously

• Characteristics
• No discernible complexes
• No rhythm pattern
• Chaotic, irregular
• Fast rate
• Wide, bizarre deflections

12
Ventricular Fibrillation (VF)

• Considerations
• No cardiac output
• Terminal rhythm if not rapidly corrected
• Most common rhythm causing sudden cardiac death

13
Asystole

• Absence of ventricular and atrial electrical
  activity
• Terminal rhythm
• May be primary arrest rhythm or follow other such
  as VF

• Characteristics
• No ventricular electrical activity
• Relatively flat line

14
Asystole

• Considerations
• No cardiac output
• VF may masquerade as asystole
• Lethal unless the CAUSE can be corrected quickly

15
Ventricular Paced Rhythms

• Electronic pacemaker causes ventricular
  depolarization
• Usually results in adequate CO
• Used with conduction system malfunction

• Characteristics
• Wide QRS
• QRS preceded by pacemaker spike
• Typically preceded by spontaneous or electronic
  atrial depolarization

16
Further Study

• Capture Beat
• Fusion Beat

• Define (specifically)
• Why are they significant?
• What rhythm(s) are they typically associated with?