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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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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
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
PVC’s May Appear Randomly
  • PVC’s May Appear In Patterns
    • Bigeminy
    • Trigeminy
  • Couplets
  • Triplets
Couplets Are Scary But Triplets Are Really Frightening
  • Triplets Are A Hair’s Breath Away From Ventricular Tachycardia
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
Appearance Of Multifocal PVC’s
  • RT On T Phenomenon
  • Ventricular Tachycardia
  • Ventricular Fibrillation
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
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.
  • 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
  • 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


Table 3-10, pp 42, 5th edition

ventricular tachycardia
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.
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
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
  • 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
  • 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
  • Characterized By :
    • Prolonged PR Interval > 5 mm
    • Every QRS Is Preceded By A P Wave
    • Every QRS Is Normal
    • No Dropped Beats
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
  • 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 !!
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
  • 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
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 AV Block Is A Dangerous Dysrhythmia Because 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.
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
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 P Waves Appear & Are Not Connected To Any QRS Complex
  • The QRS Are Abherrantly Wide
  • Ultimate Ventricular Rate Is Often Very Bradycardic
bundle branch blocks
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.