BBB and Ventricular Rhythms
ventricular fibrillation
#1 cause of cardiac arrest - No effective cardiac output - Same as asystole from CO standpoint but different electrically - Chaotic electrical activity - No organized impulse or ventricular contraction - Multiple foci are firing
Torsades de pointes
- A form of polymorphic VT - French - means "twisting of points - Describes a QRS complex that changes polarity (from negative to positive and positive to negative) as it twists around the isoelectric line• - Intermediary arrhythmia between VT and VF - Prolonged QT interval - Long QT syndrome - Electrical problem thought to be caused by changes in cardiac ion channels that affect repolarization - lengthens the refractory period (vulnerable period)
Bundle Branch Block
- Can be chronic or temporary - No specific treatment to fix - Can be rate-related (only appear at critical HR)
Asystole
- Flatline - No electrical activity - No effective cardiac output
Idioventricular Rhythm
- Originates in ventricles - QRS is: wide and bizarre (> .12 seconds) - P-waves usually not present - T wave is usually inverted - Rate: 20-40 bpm (sometimes less)
premature ventricular contraction
- QRS is early and wide - Morphology of QRS is different from underlying rhythm - No P wave (usually within the wide QRS) - ST-segment and T wave slope in the opposite direction of the main QRS
bundle branch block (BBB)
- Rhythm is regular - Block is in ventricles - Results in wide QRS (> .10 seconds) - PR interval is normal - Need 12 lead EKG to differentiate between right and left BBB
Ventricular tachycardia
- treated with vagal maneuvers if conscious with a pulse - If symptomatic: Treated electrically with defibrillation - May does not produce a pulse - Can deteriorate into ventricular fibrillation - Can occur in "runs" or "salvos" (Ex: a 10-beat run of VT)
Sustained ventricular tachycardia
>30 sec; causes decreased blood flow
Ventricular tachycardia
Causes: - Coronary artery disease - Meds - Congestive heart failure - Valve disease - Acute MI - Cardiomyopathy - Digitalis toxicity - Electrolyte imbalances (esp. hypokalemia and hypomagnesemia)
coarse ventricular fibrillation
Identify the rhythm.
Polymorphic Ventricular Tachycardia
Occurs when the QRS differs in morphology
Accelerated Idioventricular rhythm
Originates in ventricles - QRS is: wide and bizarre (> .12) - P-waves absent - Rate: 50-100
Bundle Branch Block
What Causes: coronary artery disease, myocardial infarction, pulmonary embolism, congestive heart failure, degenerative disease of the electrical system, hypertension, cardiomyopathy
idioventricular rhythm
What causes: - End-stage cardiac disease - Last rhythm of a dying heart - The electrical impulse fails to reach the ventricles because of sinus arrest, exit block, or 3rd degree AV block
Agonal rhythm
Which rhythm is this?
right, left
____ BBB can occur in healthy individuals and ____ BBB rarely occurs in healthy hearts
ventricular tachycardia
______ _______ is most likely due to reentry in the ventricles and can also be caused by enhanced automaticity
Torsades de pointes
________ is generally distinguished from polymorphic VT by known long QT syndrome or by low magnesium
Quadrigeminal PVCs
every 4th beat is a PVC
Bigeminal PVCs
every other beat is a PVC
Trigeminal PVCs
every third beat is a PVC
Ventricular tachycardia (V-tach)
originates in ventricles - QRS (>.12 sec) deflection opposite T wave -Duration: -P-waves: absent - Occurs in short runs or continuously (3 or more PVCs) Rate: 140-250
monomorphic ventricular tachycardia
presents with wide QRS complexes of a common shape.
Unsustained Ventricular tachycardia
stops spontaneously without problems with blood flow
Paired PVCs
which rhythm is this?
fine ventricular fibrillation
which rhythm is this?
