Cardiac dysrhythmias of ventricular origin
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Cardiac Dysrhythmias Of Ventricular Origin. Ectopic Ventricular Dysrhythmias. Premature Ventricular Contractions (PVC’s) Ventricular Tachycardia Ventricular Fibrillation. Premature Ventricular Contractions. PVC’s Occur In Normal Hearts As Well As Those With Pathology

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Cardiac dysrhythmias of ventricular origin
Cardiac DysrhythmiasOf Ventricular Origin


Ectopic ventricular dysrhythmias
Ectopic Ventricular Dysrhythmias

  • Premature Ventricular Contractions (PVC’s)

  • Ventricular Tachycardia

  • Ventricular Fibrillation


Premature ventricular contractions
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














Rules of malignancy
Rules Of Malignancy

  • An Ordering System For Grading The Severity Of Ventricular Ectopies


From least severe to most severe
From Least Severe To Most Severe

  • Frequent Single Focus PVC’s

  • Runs Of PVC’s

    • Quadrigeminy

    • Trigeminy

    • Bigeminy



Rt on t phenomenon
RT On T Phenomenon

  • Thought To Be Very Dangerous

  • A PVC Occurs During Ventricular Depolarization


Rt on t phenomenon1
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



Exercise
Exercise 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.

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





The acsm guidelines
The ACSM Guidelines Multiforme PVC’s Or Any PVC Rhythm (Bigeminy, etc.) Until Cleared By Their Cardiologist

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



Ventricular tachycardia
Ventricular Tachycardia Confusion, Ataxia, Pallor, Cyanosis, Nausea, Or Cold & Clammy Skin” Then

  • Ventricular Tachycardia Is Defined As A Run Of Three Or More Consecutive PVC’s

  • The Rate Is Usually Between 100-200 BPM




Ventricular tachycardia1
Ventricular Tachycardia Because The Cardiac Output Is So Negatively Effected As To Decrease Perfusion To The Brain & The Heart.





Ventricular fibrillation
Ventricular Fibrillation Requiring High Level Medical Management

  • V-Fib Is Seen In Hearts That Are Dying

  • Electrical Activity is Completely Chaotic

  • No Meaningful Cardiac Output Is Occurring


  • V-Fib Is Characterized By : Requiring High Level Medical Management

    • No True QRS Complexes

    • A Wandering Or Undulating Baseline

    • No Recognizable Atrial Wave Forms

    • No Recognizable T Waves



Ventricular fibrillation1
Ventricular Fibrillation Electrically Cardioverted Out Of This Rhythm Or Death Ensues


Exercise1
Exercise Electrically Cardioverted Out Of This Rhythm Or Death Ensues

  • 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


Atrioventricular blocks
Atrioventricular Blocks Electrically Cardioverted Out Of This Rhythm Or Death Ensues

  • First Degree AV Blocks

  • Second Degree AV Blocks

    • Mobitz Type I (Wenckebach Block)

    • Mobitz Type II

  • Third Degree AV Blocks


First degree av blocks
First Degree AV Blocks Electrically Cardioverted Out Of This Rhythm Or Death Ensues

  • Characterized By :

    • Prolonged PR Interval > 5 mm

    • Every QRS Is Preceded By A P Wave

    • Every QRS Is Normal

    • No Dropped Beats


First degree av block
First Degree AV Block Electrically Cardioverted Out Of This Rhythm Or Death Ensues


First degree av block1
First Degree AV Block Electrically Cardioverted Out Of This Rhythm Or Death Ensues


  • Causes : Electrically Cardioverted Out Of This Rhythm Or Death Ensues

    • Drug Toxicity

    • Ischemic Heart Disease Of The Heart’s Conduction System

    • Myocarditis



Exercise2
Exercise Well As In Those With Ischemic Heart Disease

  • Can I Exercise A Patient In First Degree AV Block ?

  • Yes, But The Rhythm Must Not Degenerate During Exercise To Second Degree AV Block.






Mobitz type i
Mobitz Type I Characterized By :


Exercise3
Exercise Characterized By :

  • Can I Exercise A Patient In A Mobitz Type I Second Degree AV Block ?





  • Characteristics Are : Exercise.

    • A Series Of Normal Beats

    • All PR Intervals Are Normal Duration

    • Sudden Dropped Beat - No QRS

    • Normal Rhythm Re-Established

    • Cycle Begins Again


Mobitz type ii
Mobitz Type II Exercise.


Mobitz type ii1
Mobitz Type II Exercise.



Exercise4
Exercise Of The High Likelihood That It Will Convert To A Third Degree AV Block.

  • Can I Exercise A Patient In A Mobitz Type II AV Block ?

  • No. The Risk Is Too High That The Patient Will Convert To Third Degree AV Block.



Third degree av block
Third Degree AV Block Convert To A Third Degree Block & Is A Candidate For A Surgically Implanted Pacemaker

  • This Is A Serious Condition In Which There Is No Communication Of The SA Node With The AV Node. It Is Also Called Complete Heart Block.




3rd degree av block
3rd Degree AV Block At Their Own Rate



Bundle branch blocks
Bundle Branch Blocks Implantation Of A Pacemaker.

  • Right Bundle Branch Block

    • RSR’ (Bunny Ears) In V1-V4

    • Loss Of The R Wave Progression

    • ST Segment Depression In V1 - V4

    • T Wave Inversion In V1 - V4

    • Wide QRS Complexes



  • Left Bundle Branch Block Implantation Of A Pacemaker.

    • Loss of the R wave progression

    • Huge S waves in V1 - V4

    • RSR’ in V4 - V6

    • Wide QRS complexes

    • ST segment depression in V4 - V6

    • T Wave inversion in V4 - V6



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