![]() Non-sustained monomorphic ventricular tachycardia, 17 beats. It is a sign of coronary reperfusion, so its appearance in a ST-segment elevation myocardial infarction indicates a good prognosis. The electrocardiogram shows a rhythm with QRS complexes that have ventricular morphology (similar to ventricular tachycardia) but with low rates (between 60 and 110 bpm) and gradual onset and termination that set it apart from ventricular tachycardia, which usually starts with a premature ventricular complex. Accelerated Idioventricular RhythmĪccelerated idioventricular rhythm (AIVR) is mainly observed after the reperfusion of an occluded artery in an acute coronary syndrome and is caused by an abnormal automatism of the ventricles. Normally no P waves are seen, but disassociated P waves or retrograde P waves could be seen less often. Sometimes it is impossible to tell a ventricular escape rhythm apart from a junctional escape rhythm with associated bundle branch block. Ventricular escape rhythm is observed on the electrocardiogram as a slow, regular rhythm (between 20 and 50 bpm) with broad QRS complexes. Ventricular escape rhythm or idioventricular rhythm occurs in the absence of supraventricular stimuli or with bradycardias with heart rate below 40 bpm ( sick sinus syndrome or complete AV block distal to the bundle of His) 3. ![]() Ventricular Escape Rhythm or Idioventricular Rhythm Nonsustained ventricular tachycardia: three or more consecutive PVCs. ![]() Ventricular quadrigeminy: every third sinus beat is followed by a PVC.Ventricular trigeminy: every second sinus beat is followed by a PVC.Ventricular bigeminy: every sinus beat is followed by a premature ventricular complex.Isolated PVC: there is no regular repeating pattern.Occasional: fewer than 10 PVCs per hour, or fewer than 5 per minute.Frequent: 10 or more PVCs per hour, or 6 PVCs or more per minute.Multifocal: presence of PVCs with different morphologies.Unifocal: every premature ventricular complex presents the same morphology.Premature Ventricular Complexes Classification According Number of Foci: Full compensatory pause: after the PVCs a delay occurs until the appearance of basic rhythm.The premature ventricular complex is not preceded by a P wave.It is accompanied by ST-segment and T wave changes. Abnormal QRS complex in duration and morphology.Premature QRS complex in relation to the expected impulse of the basic rhythm.Atrial fibrillation/ atrial flutter with variable AV conduction AND accessory pathway (e.g.Premature Ventricular Complexes on the Electrocardiogram.Atrial fibrillation/ atrial flutter with variable AV conduction AND bundle branch block^.Accelerated idioventricular rhythm (consider if less than or ~120 bpm).Sinus tachycardia with bundle branch block^.Atrial flutter with bundle branch block^.Atrial flutter with variable conductionĪssume any wide-complex tachycardia is ventricular tachycardia until proven otherwise (it is safer to incorrectly assume a ventricular dysrhythmia than supraventricular tachycardia with abberancy).Sinus tachycardia with frequent PACs, PJCs, PVCs. ![]() Paroxysmal supraventricular tachycardia (PSVT).Idiopathic fascicular left ventricular tachycardia.Atrial tachycardia (uni-focal or multi-focal).Past medical hx may include recent cardiovascular surgeryÄifferential Diagnosis Narrow-complex tachycardia.Clinical features vary widely, diagnosis usually made via ECG. ![]()
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