6
At least 3-4 PVCs in a row
Non-sustained ventricular tachycardia ***
- PVCs can have different morphologies (shapes)
- The pause surrounding the PVC is equal to double the preceding R-R interval ( = a full compensatory pause)
- Note the approximately discordant ST segments/T waves
Multifocal PVCs
Should you monitor or change PT session for sustained/non-sustained Vtach/Vfib?
Yes.. defer PT for more than 7 bpm
Hiccup between atria and ventricle
Atrial impulses delayed or not getting conducted to the ventricles
Heart block (AV block)
- NONE of the atrial impulses are being conducted to the ventricles, despite adequate opportunity for it to occur
- Atria will fire but not synchronize with or reach the ventricles
- Occasional foci escape to pace the ventricles at their inherent rate (pulse rate of 20-40 bpm)
- As a result PVC-like QRS complexes will appear, but only when automaticity foci pace ventricles
- No communication between atria and ventricle
- Have to have a pacemaker and defibrillator if the EF is low
Third degree AV block (complete)
T/F: The more frequent premature beat patterns occur, the more irritated the heart
True
- Tall sinusoidal waves
- Sustained V tach can deteriorate into V-fib or V-flutter
Ventricular tachycardia
- Occurs before the next expected regular beat in the cycle
- QRS is wide (> 0.12 seconds) and can appear bizarre
Premature ventricular contraction (PVC)
Name the different degrees of heart blocks in order from least severe to most severe?
1. First degree HB
2. Second degree HB
- Mobitz type I
- Mobitz type II
3. Third degree (complete) HB
PR interval being delayed results in ...
Heart block .. AV rhythm
250-350/min
- Maintaining V tach without normal rhythm ever
Ventricular flutter
If patient has more than how many PVC's in a minute do we defer PT?
7 or more
V tach that happens every 30 seconds of monitoring in a minute; "bounce in and out"
Non-sustained V tach
SA node is supposed to be the primary electrical conductor. AV node is generating the conduction.
AV Nodal rhythms / junctional rhythms
- Some atrial impulses are NOT conducted to the ventricles:
- PR interval progressively lengthens until a beat is dropped.
- If often resolves spontaneously, otherwise responds well to atropine medication
- QRS complexes are narrow
Second degree AV block (type I)
Is there any potential risk with a PVC rhythm?
Can the patient feel them?
Should you monitor PT session?
1. YES... 1 PVC can be felt "heart skipped a beat"
2. YES
3. Yes.. if they say they are actively feeling it, let them know to keep track how frequently it is; will feel it on manual pulse; diet/drinks different than normal (energy drinks)
- A "generic" term for any tachycardia originating above the ventricles, but after the atria
- Typically produce a narrow-complex QRS
- Different types arise from or are propagated by the atria or AV node
- Can be resolved with vagal (Valsalva) maneuver to reset HR
Supraventricular tachycardia (SVT)
- Heights of the waves will vary depending on state of the heart
- Lower amplitude can indicate proximity to cardiac arrest
Ventricular fibrillation
1. Every PRI exceeds 0.2 seconds (5 small boxes)
2. PR intervals are fixed
3. ALL atrial impulses get conducted to the ventricles, just delayed
4. HR and rhythm will be NORMAL
- R's can still be even
- May look normal at first glance
- Most patients dont know they have it and doesnt always progress
First degree AV block
- Constant PR interval with consecutively conducted beats until one or more beats are dropped
- More P waves than QRS and the QRS complexes are generally wide
- Usually does NOT respond to atropine and more likely to need PACING for tx
- HR now reduced a bit and rhythm will be irregular
- Can lead to syncope; after 2-3 syncopal episodes, pacemaker is placed
Second degree AV block (type II)
A pacemaker strike right before the P wave indicates what?
Atrial pacemaker
Can patient feel SVT?
Yes.. heart palpitations
A pacemaker strike right before the QRS wave indicates what?
Ventricular help
ST elevation - S stays elevated and does not go back to neutral; more concerning and higher link to death
- Leads to Q wave MI
STEMI -- MI
Why is elevation of ST wave more concerning than depression?
Because ventricle is not relaxing