Cardiac Dysrhythmias Of Ventricular Origin

1. Cardiac DysrhythmiasOf Ventricular Origin

2. Ectopic Ventricular Dysrhythmias • Premature Ventricular Contractions (PVC’s) • Ventricular Tachycardia • Ventricular Fibrillation

3. Premature Ventricular Contractions • PVC’s Occur In Normal Hearts As Well As Those With Pathology • People With Thousands Of PVC’s Per Day Can Be Normal • PVC’s Can Also Be An Ominous Sign Of Disease

4. Characteristics Of PVC’s Are : • PVC’s Are Premature Beats • The P Wave Is Absent • QRS Complex Is Wide & Bizarre • A Compensatory Pause Follows The PVC

5. Premature Ventricular Contractions

6. Premature Ventricular Contractions

7. PVC’s May Appear Randomly • PVC’s May Appear In Patterns • Bigeminy • Trigeminy

8. Bigeminy

9. Bigeminy

10. Trigeminy

11. Quadrigeminy • Couplets • Triplets

12. Couplets

13. Triplets

14. Couplets Are Scary But Triplets Are Really Frightening • Triplets Are A Hair’s Breath Away From Ventricular Tachycardia

15. Multiform PVC’s

16. Rules Of Malignancy • An Ordering System For Grading The Severity Of Ventricular Ectopies

17. From Least Severe To Most Severe • Frequent Single Focus PVC’s • Runs Of PVC’s • Quadrigeminy • Trigeminy • Bigeminy

18. Appearance Of Multifocal PVC’s • RT On T Phenomenon • Ventricular Tachycardia • Ventricular Fibrillation

19. RT On T Phenomenon • Thought To Be Very Dangerous • A PVC Occurs During Ventricular Depolarization

20. RT On T Phenomenon • Why Is It Dangerous ? • The Cardiac Cells Are Various Stages Of Depolarization - Some Have Repolarized While Others Are In Various Stages Of Repolarization

21. 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.

22. Exercise • Can I Exercise A Patient Who Is Having PVC’s ?

23. Yes, You Can Exercise A Patient Having PVC’s. However, They Should Only Be Occasional Single Focus Single PVC’s.

24. If The Exercise Regimen Makes The Incidence Of PVC’s Occur More Often Or If The PVC’s Become More Malignant, Exercise Should Be Terminated.

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

26. The ACSM Guidelines • The ACSM Guidelines State :If There Is A “Noticeable Change In Heart Rhythm”….

27. ...or “Signs Of Poor Perfusion: Light Headedness, Confusion, Ataxia, Pallor, Cyanosis, Nausea, Or Cold & Clammy Skin” Then STOP THE EXERCISE !!! Table 3-10, pp 42, 5th edition

28. Ventricular Tachycardia • Ventricular Tachycardia Is Defined As A Run Of Three Or More Consecutive PVC’s • The Rate Is Usually Between 100-200 BPM

29. Short Runs Of V-Tach Will Make The Patient Feel : • Dizzy • Have Palpitations • Feel Faint • Be Short Of Breath

30. 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.

31. Ventricular Tachycardia

32. Ventricular Tachycardia Will Degenerate Quickly Into Ventricular Fibrillation

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

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

35. Ventricular Fibrillation • V-Fib Is Seen In Hearts That Are Dying • Electrical Activity is Completely Chaotic • No Meaningful Cardiac Output Is Occurring

36. V-Fib Is Characterized By : • No True QRS Complexes • A Wandering Or Undulating Baseline • No Recognizable Atrial Wave Forms • No Recognizable T Waves

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

38. Ventricular Fibrillation

39. Exercise • Exercise Cannot be Sustained In Patients With V-Tach Or V-Fib Because 99.99 % Of The Time They Will Be Unconscious - Exercise Is Never An Option

40. Atrioventricular Blocks • First Degree AV Blocks • Second Degree AV Blocks • Mobitz Type I (Wenckebach Block) • Mobitz Type II • Third Degree AV Blocks

41. First Degree AV Blocks • Characterized By : • Prolonged PR Interval > 5 mm • Every QRS Is Preceded By A P Wave • Every QRS Is Normal • No Dropped Beats

42. First Degree AV Block

43. First Degree AV Block

44. Causes : • Drug Toxicity • Ischemic Heart Disease Of The Heart’s Conduction System • Myocarditis

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

46. Exercise • Can I Exercise A Patient In First Degree AV Block ? • Yes, But The Rhythm Must Not Degenerate During Exercise To Second Degree AV Block.

47. 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 !!

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

49. Second Degree AV Block Mobitz Type I Or A Wenckebach Block

50. Second Degree AV Block Or A Mobitz Type I AV Block Is Characterized By : • Progressively Lengthening PR Interval • A Sudden Dropped QRS Complex • Return Of A Normal Rhythm • A Repeating Cycle