Cardiac Dysrhythmias Of Ventricular Origin

9/20/99


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Table of Contents

Cardiac Dysrhythmias Of Ventricular Origin

Ectopic Ventricular Dysrhythmias

Premature Ventricular Contractions

Characteristics Of PVCs Are :

Premature Ventricular Contractions

Premature Ventricular Contractions

PVCs May Appear Randomly

Bigeminy

Bigeminy

Trigeminy

Quadrigeminy

Couplets

Triplets

Couplets Are Scary But Triplets Are Really Frightening

Multiform PVCs

Rules Of Malignancy

From Least Severe To Most Severe

Appearance Of Multifocal PVCs

RT On T Phenomenon

RT On T Phenomenon

A Stimulus That Occurs Before Repolarization Is Finished Will Set Off A Disorganized Electrical Response To The Stimulus & May Set The Heart Up For A Malignant Ventricular Ectopy Like V-Tach Or V-Fib.

Exercise

Yes, You Can Exercise A Patient Having PVCs. However, They Should Only Be Occasional Single Focus Single PVCs.

If The Exercise Regimen Makes The Incidence Of PVCs Occur More Often Or If The PVCs Become More Malignant, Exercise Should Be Terminated.

A Person Should Not be Exercised When They Are Displaying Multiforme PVCs Or Any PVC Rhythm (Bigeminy, etc.) Until Cleared By Their Cardiologist

The ACSM Guidelines

...or Signs Of Poor Perfusion: Light Headedness, Confusion, Ataxia, Pallor, Cyanosis, Nausea, Or Cold & Clammy Skin Then

Ventricular Tachycardia

Short Runs Of V-Tach Will Make The Patient Feel :

Sustained Runs OF V-Tach Will Render The Patient Unconscious Because The Cardiac Output Is So Negatively Effected As To Decrease Perfusion To The Brain & The Heart.

Ventricular Tachycardia

Ventricular Tachycardia Will Degenerate Quickly Into Ventricular Fibrillation

The Patient In V-Tach Must Be Supported With CPR Methods & Must Be Cardioverted Electrically Or Pharmacologically Out Of This Fatal Rhythm

Both V-Tach & V-Fib Are Absolute Medical Emergencies Requiring High Level Medical Management

Ventricular Fibrillation

V-Fib Is Characterized By :

The Patient Must Be Supported By CPR Methods & Must Be Electrically Cardioverted Out Of This Rhythm Or Death Ensues

Ventricular Fibrillation

Exercise

Atrioventricular Blocks

First Degree AV Blocks

First Degree AV Block

First Degree AV Block

Causes :

First Degree AV Block Does Appear In Healthy Individuals As Well As In Those With Ischemic Heart Disease

Exercise

Also, The Rhythm Had To Have Been Present Before Exercise Started. If A Patient Is Normal On Their EKG Before Exercise & Degenerates Into First Degree AV Block, Exercise Must Stop !!

First Degree AV Block Is Generally Not Considered To Be A Highly Malignant Dysrhythmia

Second Degree AV Block Mobitz Type I Or A Wenckebach Block

Second Degree AV Block Or A Mobitz Type I AV Block Is Characterized By :

Mobitz Type I

Exercise

Yes, Providing The Dysrhythmia Does Not Degenerate During Exercise.

A Problem Does Exist With A Mobitz Type I AV Block !!

Second Degree AV Block Mobitz Type II

Characteristics Are :

Mobitz Type II

Mobitz Type II

Mobitz Type II AV Block Is A Dangerous Dysrhythmia Because Of The High Likelihood That It Will Convert To A Third Degree AV Block.

Exercise

A Patient With A Mobitz Type II AV Block Is Going Eventually Convert To A Third Degree Block & Is A Candidate For A Surgically Implanted Pacemaker

Third Degree AV Block

The Atria Beat At Their Own Rate While The Ventricles Beat At Their Own Rate

The P Waves Appear & Are Not Connected To Any QRS Complex

3rd Degree AV Block

Most Patients In Third Degree AV Block Require The Implantation Of A Pacemaker.

Bundle Branch Blocks

Can you exercise a patient in RBBB ?

Left Bundle Branch Block

Can you exercise a person in LBBB ?

Author: Microsoft Corporation

Email: David.Arnall@NAU.EDU , DAArnall@AOL.COM

Home Page: http://jan.ucc.nau.edu/~daa/heartlung/

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