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Sunday, April 29, 2018

Premature Ventricular Complex (PVC), Idioventricular Rhytm (IVR), Accelerated Idioventricular Rhytm (AIVR), Ventricular Tachicardia (VT),Ventricular Fibrilation (VFib), Agonal Rhytm

Kapevi Hatake | 10:32 AM |
Premature Ventricular Complex (PVC), Idioventricular Rhytm (IVR), Accelerated Idioventricular Rhytm (AIVR), Ventricular Tachicardia (VT),Ventricular Fibrilation (VFib), Agonal Rhytm


Sinus Rhytm with Premature Ventricular Complex (NSR with PVC)
Premature ventricular complete (PVC) often represent increased ventricular automaticaly or recentry phenomenon. The presence of PVC may be benign but can indicated irritable ventricles. PVC’s arrive earlier than expected and is usually widw (0,12 second or more). Note that the T wave often points in an opposite direction from the QRS complex. A PVC every second complex is called ventricular bigeminy...every 3rd-ventricular trigeminy.


Idioventricular Rhytm (IVR)
Idioventricular rhytm (IVR) occurs when the SA and AV nodes are  either NOT fiiring or firing slower than the ventricular pacemaker rate. A common ventricular pacemaker rate is 20-40/minute, a rate that is often not sufficient to sustain an adequate cardiac output

Accelerated Idioventricular Rhytm (AIVR)
Accelerated Idioventricular Rhytm (AIVR) is a ventricular rhytm occuring at a rate between 41-100/minute – faster than typical pacemaker rates expected of the ventricles (20-40/minute) and less than what is considered a tachicardia (>100/minutes). Enhanced automaticity-possibly due to hipoxia or abundant sympathetic stimulation -  increases rate of ventricular electrical impulses. Note that this rhytm is often unstable and can move quickly to either asystole or ventricular tavhicardia (VT)


  
Ventricular Tachicardia (VT)
Ventricular Tachicardia (VT) often result in hemodynamic compromise (due to minimal ventricular filling time and the absence of atrial kick). What makes this rhytm more omnius is it tendency to transition into ventricular fibrilation. Causes of VT include myocardial ischemia, a PVC landing on a T wave (R-on-T), cardiac drug toxicity and electrolyte imbalance. Non-sustained VT (a group of 3 or more PVCs) is a run of VT.


Ventricular Fibrilation (VFib)
Ventricular Fibrilation (Vfib) is a chaotic rhytm originating in the ventricles, resulting in no cardiac output. Coarse Vfib is noted when the amplitude (height) of the rhytm is equal to or more than 3 mm. Fine Vfib is less than 3 mm in height and signifies less electrical energi within the myocardium-less opportunity for a successful defibrilation.


Agonal Rhytm
Agonal Rhytm-typically an extreme ventricular bradycardia-is considered an end stage cardiac rhytm with asystole quickly ensuing. The  QRS complexes tend to be very wide and flattened. The relative absence of cardiac output often results in a pulseless patient.

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Sumber Pustaka: SkillStat Learning.Inc. 2005

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