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

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Cardiac DysrhythmiasOf 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

  • People With Thousands Of PVC’s Per Day Can Be Normal

  • PVC’s Can Also Be An Ominous Sign Of Disease


  • 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


Premature Ventricular Contractions


Premature Ventricular Contractions


  • PVC’s May Appear Randomly

  • PVC’s May Appear In Patterns

    • Bigeminy

    • Trigeminy


Bigeminy


Bigeminy


Trigeminy


  • Quadrigeminy

  • Couplets

  • Triplets


Couplets


Triplets


  • Couplets Are Scary But Triplets Are Really Frightening

  • Triplets Are A Hair’s Breath Away From Ventricular Tachycardia


Multiform PVC’s


Rules Of Malignancy

  • An Ordering System For Grading The Severity Of Ventricular Ectopies


From Least Severe To Most Severe

  • Frequent Single Focus PVC’s

  • Runs Of PVC’s

    • Quadrigeminy

    • Trigeminy

    • Bigeminy


  • Appearance Of Multifocal PVC’s

  • RT On T Phenomenon

  • Ventricular Tachycardia

  • Ventricular Fibrillation


RT On T Phenomenon

  • Thought To Be Very Dangerous

  • A PVC Occurs During Ventricular Depolarization


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


  • 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

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


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


  • 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.


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


The ACSM Guidelines

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


  • ...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


Ventricular Tachycardia

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

  • The Rate Is Usually Between 100-200 BPM


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

    • Dizzy

    • Have Palpitations

    • Feel Faint

    • Be Short Of Breath


  • 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 Seen In Hearts That Are Dying

  • Electrical Activity is Completely Chaotic

  • No Meaningful Cardiac Output Is Occurring


  • V-Fib Is Characterized By :

    • No True QRS Complexes

    • A Wandering Or Undulating Baseline

    • No Recognizable Atrial Wave Forms

    • No Recognizable T Waves


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


Ventricular Fibrillation


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


Atrioventricular Blocks

  • First Degree AV Blocks

  • Second Degree AV Blocks

    • Mobitz Type I (Wenckebach Block)

    • Mobitz Type II

  • Third Degree AV Blocks


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


First Degree AV Block


First Degree AV Block


  • Causes :

    • Drug Toxicity

    • Ischemic Heart Disease Of The Heart’s Conduction System

    • Myocarditis


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


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.


  • 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 :

    • Progressively Lengthening PR Interval

    • A Sudden Dropped QRS Complex

    • Return Of A Normal Rhythm

    • A Repeating Cycle


Mobitz Type I


Exercise

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


  • Yes, Providing The Dysrhythmia Does Not Degenerate During Exercise.

  • The Patient Must Also Have Been Cleared For Exercise


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

  • You Have To Be Concerned That It Will Degenerate Into A Mobitz Type II AV Block


Second Degree AV Block Mobitz Type II


  • Characteristics Are :

    • 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


  • 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

  • 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.


  • 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

  • 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.


  • 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

  • The QRS Are Abherrantly Wide

  • Ultimate Ventricular Rate Is Often Very Bradycardic


3rd Degree AV Block


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


Bundle Branch Blocks

  • 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


  • Can you exercise a patient in RBBB ?

  • Yes as long as they have been cleared by their physician.


  • Left Bundle Branch Block

    • 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


  • Can you exercise a person in LBBB ?

  • Yes, as long as the patient has been cleared by their physician.


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