37 Questions
What are the symptoms of Ventricular Escape?
Palpitations, decreased cardiac output and blood pressure, dizziness, syncope, confusion, breathlessness, and decreased urine output.
What is the treatment for symptomatic Ventricular Escape?
Follow the ARC bradycardia algorithm.
What is the heart rate range for Ventricular Tachycardia (VT)?
110-250 bpm.
What is the duration required for a rhythm to be considered Ventricular Tachycardia (VT)?
More than 30 seconds.
What is the most common underlying mechanism of Ventricular Tachycardia (VT)?
re-entry, often due to scar tissue from a previous myocardial infarction
What is the most common cause of Ventricular Tachycardia (VT)?
ischemic heart disease (MI or acute ischemia, prior MI, post-reperfusion)
What is the polymorphic form of ventricular tachycardia resulting from prolonged ventricular repolarization?
long QT
What other conditions can cause Ventricular Tachycardia (VT), aside from ischemic heart disease?
dilated and hypertrophic cardiomyopathy, electrolyte abnormalities, mechanical stimulation, and digoxin toxicity
What is the name of the condition that occurs when there is a prolonged period of time between ventricular contractions?
long QT
What is the first step in treating Torsades de Pointes?
Administer IV magnesium and potassium
What is the 'R on T phenomenon'?
Initiated when a PVC occurs during the preceding T wave (relative refractory period)
What should be avoided in the treatment of Torsades de Pointes?
Inotropes
What is a congenital cause of Torsades de Pointes?
Congenital long QT syndrome
What is a potential treatment for Torsades de Pointes?
Atrial or ventricular overdrive pacing
What is a common cause of Torsades de Pointes?
Drug-induced and electrolyte abnormalities
What is required for treatment of Torsades de Pointes?
Immediate intervention with defibrillation
What should be discontinued in the treatment of Torsades de Pointes?
Drugs that prolong the QT interval
What occurs when the SA node fails and the backup pacemaker in the AV junction also fails?
The ventricular focus takes over, resulting in ventricular escape beats.
What is ventricular escape rhythm defined as?
Three or more consecutive ventricular beats in a row.
What is the rate of ventricular escape rhythm?
20-40 bpm
What is the characteristic of the QRS complex in ventricular escape rhythm?
Wide and bizarre
What is the opposite polarity of the T wave compared to the QRS complex?
Yes, the T wave has an opposite polarity compared to the QRS complex.
What is the rate of accelerated idioventricular rhythm (AIVR)?
40-100 bpm
What is the characteristic of the rhythm in accelerated idioventricular rhythm (AIVR)?
Regular
What are the conditions that can cause PVCs?
Electrolyte imbalances, metabolic acidosis, hypoxia, myocardial ischemia, ventricular hypertrophy, antiarrhythmic drugs, sympathomimetic drugs, infection, excessive alcohol intake, and stimulants
What is the difference between unifocal and multifocal PVCs?
Unifocal PVCs have the same ectopic focus, while multifocal PVCs have different ectopic foci
What is bigeminy, and what does it indicate?
Bigeminy is a pattern where every second beat is a PVC, and it is a concerning pattern
What is the R on T phenomenon, and what is its significance?
The R on T phenomenon occurs when a PVC 'lands' on the T wave of a QRS complex, and it can lead to ventricular tachycardia or fibrillation
What is the role of beta-blockers in managing PVCs, especially post-MI?
Beta-blockers can be used to manage PVCs, especially post-MI, to reduce the risk of more serious arrhythmias
What is the purpose of combining beta-blockers and amiodarone in high-risk patients?
Combining beta-blockers and amiodarone can be safely administered to high-risk patients to reduce the risk of more serious arrhythmias
What is trigeminy, and what does it indicate?
Trigeminy is a pattern where every third beat is a PVC, and it is a concerning pattern
When can amiodarone IV be used acutely?
Amiodarone IV can be used acutely to manage PVCs
whats the treatment for PVC
A combination of beta-blockers and amiodarone can be safely administered to high-risk patient
whats R on T Phenomenon
Occurs when a PVC "lands" on the T wave of a QRS complex ventricular tachycardia or fibrillation
Torsades de Pointes (TdP) mechanism
Initiated when a PVC occurs during the preceding T wave (relative refractory period)‘ R on T phenomenon
R on T Phenomenon
Occurs when a PVC "lands" on the T wave of a QRS complex This can be significant and lead to ventricular tachycardia or fibrillation
Torsades de Pointes initiates with
when a PVC occurs during the preceding T wave (relative refractory period)‘ R on T phenomenon
Study Notes
Ventricular Rhythms
- Ventricular escape can cause palpitations, decreased cardiac output and blood pressure, dizziness, syncope, confusion, and breathlessness.
- Ventricular escape rhythm occurs when there are three or more ventricular escape beats in a row, characterized by a regular rhythm, rate of 20-40 bpm, wide and bizarre QRS, and T waves of opposite polarity to the QRS.
Ventricular Tachycardia (VT)
- VT is a potentially life-threatening rhythm that requires immediate attention.
- Sustained for more than 30 seconds, with a heart rate of 110-250 bpm, a regular rhythm, and wide and bizarre QRS complexes.
- Mechanism is often re-entry, often due to scar tissue from a previous myocardial infarction.
- Most common causes are ischemic heart disease, dilated and hypertrophic cardiomyopathy, and other causes like electrolyte abnormalities, mechanical stimulation, and digoxin toxicity.
- Hemodynamic compromise in VT can worsen due to rapid rate, decreased ventricular filling time, and AV dissociation and loss of atrial kick.
Torsades de Pointes (TdP)
- A polymorphic form of ventricular tachycardia resulting from prolonged ventricular repolarization (long QT).
- Initiated when a PVC occurs during the preceding T wave (relative refractory period) - R on T phenomenon.
- Causes include acquired factors (drug-induced, electrolyte abnormalities, bradycardia, CVA, starvation) and congenital long QT syndrome.
- Treatment involves addressing the underlying cause, discontinuing drugs that prolong the QT interval, administering IV magnesium and potassium, and considering atrial or ventricular overdrive pacing.
Premature Ventricular Complexes (PVCs)
- Causes include electrolyte imbalances, metabolic acidosis, hypoxia, myocardial ischemia, ventricular hypertrophy, antiarrhythmic drugs, sympathomimetic drugs, infection, excessive alcohol intake, and stimulants.
- Types of PVCs include unifocal (same ectopic focus) and multifocal (different ectopic foci).
- Bigeminy (every second beat is a PVC) and trigeminy (every third beat is a PVC) are concerning patterns.
R on T Phenomenon
- Occurs when a PVC "lands" on the T wave of a QRS complex.
- This can lead to ventricular tachycardia or fibrillation.
Accelerated Idioventricular Rhythm (AIVR)
- Consists of three or more consecutive ventricular beats with a rate of 40-100 bpm.
- ECG characteristics include a usually regular rhythm, rate of 40-100 bpm, and wide and bizarre QRS complexes.
- The sinus and ventricular pacemakers compete for dominance.
Identify different types of ECG rhythms based on their characteristics. This quiz covers regular rhythm, gradual onset and termination, wide and bizarre QRS, and T rhythms.
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