1. DR.P.VIJAYARAGHAVAN’S UNIT
DR.C.R.RAJAKUMAR

2.  65 YRS old male came OPD
 C/O
 shortness of breath, palpitation
 Known DM,SHT on regular treatment
 O/E
Pts GC fair
 Pulse - 94/min, irregularly irregular
 BP- 100/70 mmHg
 CVS - S1S2 Heard ,no murmurs
 RS - NVBS , no added sounds
 P/A – Soft, no organomegaly
 CNS- NFND

5. ; Rate- 100/min
 Axis lt axis -30
 sinus beat interspersed with broad QRS complexes
SINUS BEAT;
P-wave predominently negative component in V1
PR interval-0.16 seconds
QRS duration 0.12 seconds
ST depression T –inversion in L1,AVL,V5-V6
Tall R wave in V5-V6[>20mm]

6. BROAD QRS COMPLEXES
 BROAD ,BIZZARE COMPLEXES[0.16 SECS]
Varying morphology
RBBB Pattern
Constant coupling interval for most of the complexes
No compensatory pause
Secondary ST-T changes present

7.  INFERENCE;
 LAE [lt atrial enlargement]
 LVH [Lt ventricular enlargement]
 VPC[ventricular pre mature complexes]
 Possible site of origin [lt ventricle]
 Multifocal
 Interpolated VPC
 TRIPLETS

8.  VPC [ventricular pre mature complexes]
 Characterized by the pre mature occurance of a QRS
complex that is abnormal in shape and has a duration
usually exceeding the dominent QRS complex
generally >120 milliseconds
 T wave is commonly large and opposite in direction to
the major deflexion of the QRS
 Fully compensatory pause usually follows a VPC
 Interval between the P wave of the sinus impulse
immediately before the vpc and the first sinus p wave
after the vpc equal to twice of the sinus cycle length

9. VPC MAY OCCUR
Bigeminy-every sinus beat is followed by a VPC
Trigeminy-every 2 sinus beats are followed by a VPC
Quatrigeminy-every 3 sinus beats followed by a VPC
 2 successive vpcs- COUPLET or PAIR
 3 successive vpcs- TRIPLET
INTERPOLATED VPC-is an extra systole which is, so to
speak ,sandwiched between two conducted sinus beats
3-5 consecutive impulse - SALVOS
3 or more successive vpc s at a rate of 120 or more lasting 30
seconds or more - VT
 from 6 consecutive ectopic impulses to runs lasting upto
30 seconds - NON SUSTAINED VT

10.  VPC with identical contour and coupling –single
focus initiated by reentry
 VPC with identical contour but varying coupling-
parasystolic ventricular focus or reentry when there is
delay in the reentry pathway
 VPC withVariable contour but fixed coupling-
single focus but transmitted variably through
ventricles
 VPC with variable contour and coupling- more then
one focus

11.  CLINICAL FEAUTERS;
 Palpitation , chest discomfort, neck pain, hypotension,
heart failure
 Prevalance of the VPC INCRESED BY
 Age , male sex, hypokalemia, infection, ischemic or
inflamed myocardium, Hypoxia,anasthesia,surgery

12. MANAGEMENT
 Absence of heart disease – reassurance and
avoidance of potentially aggravating factors
[coffee,tobcco,environmental stress or stimulants]
-Mild anxiolytic drugs,or beta blockers
 VPC with slow rate-atropine,isoproterenol,or pacing
 Vpc with fast rate- slowing heart rate
 May be treated with
IV lidocaine , procainamide, propronolal,iv
magnesium

13. Thank you