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Pre mature ventricular complex
- 1. PREMATURE VENTRICULAR COMPLEXES PREPARED BY, VANAJA.R, MSN, CRITICAL CARE NURSE EDUCATOR
- 2. INTRODUCTION • Premature ventricular contractions (PVCs) are extra heartbeats that begin in one of your heart's two lower pumping chambers (ventricles). These extra beats disrupt your regular heart rhythm, sometimes causing you to feel a fluttering or a skipped beat in your chest. • If you have occasional premature ventricular contractions, but you're otherwise healthy, there's probably no reason for concern, and no need for treatment. If you have frequent premature ventricular contractions or underlying heart disease, you might need treatment.
- 3. • OVERVIEW • Premature ventricular contractions are common — they occur in many people. They're also called: • Premature ventricular complexes • Ventricular premature beats • Ventricular extrasystoles
- 4. PATHOPHYSIOLOGY • The rhythm of your heart is normally controlled by the sinoatrial (SA) node — or sinus node — an area of specialized cells in the right atrium. • This natural pacemaker produces the electrical impulses that trigger the normal heartbeat. From the sinus node, electrical impulses travel across the atria to the ventricles, causing them to contract and pump blood to your lungs and body. • PVCs are abnormal contractions that begin in the ventricles. These extra contractions usually beat sooner than the next expected regular heartbeat. And they often interrupt the normal order of pumping, which is the atria first, then the ventricles.
- 5. CAUSES following can increase your risk of PVCs: • Caffeine , tobacco, alcohol and illicit drugs • Exercise — if you have certain types of PVCs • High blood pressure (hypertension) • Anxiety • Heart disease, including congenital heart disease, coronary artery disease, heart attack, heart failure and a weakened heart muscle (cardiomyopathy)
- 6. TYPES OF PVC Classification PVCs may be either: • Unifocal — arising from a single ectopic focus; each PVC is identical • Multifocal — arising from two or more ectopic foci; multiple QRS morphologies • The origin of each PVC can be discerned from the QRS morphology: • PVCs arising from the right ventricle have a left bundle branch block morphology (dominant S wave in V1) • PVCs arising from the left ventricle have a right bundle branch block morphology (dominant R wave in V1)
- 7. Classification PVCs often occur in repeating patterns: • Bigeminy — every other beat is a PVC • Trigeminy — every third beat is a PVC • Quadrigeminy — every fourth beat is a PVC • Couplet — two consecutive PVCs • NSVT — between three and thirty consecutive PVCs (see below)
- 8. MULTIFOCAL SInus rhythm with PVCs of two different morphologies (arrows) Note the appropriately discordant ST segments / T waves The pause surrounding the PVC is equal to double the preceding R-R interval (= a full compensatory pause)
- 9. BIGEMINY
- 10. TRIGEMINY
- 11. QUADRIGEMINY
- 12. • PVC PAIRS COUPLETS • NON SUSTAINED VT(NSVT)
- 13. Characteristics of VPB The characteristics of VPBs that confer poor prognosis include: • An "arrhythmic burden" with VPBs more than 500 in 24 hours on Holter monitoring • VPBs morphologies with LBBB or RBBB • VPBs with intermediate or superior axis and wide QRS complexes • Short-coupled VPBs • VPBs superimposed on preceding T-waves • VPBs induced by adrenergic stimulation
- 14. Management • Life style management • Antiarrythmic drugs(ex: cardrone) • Conservative treatment • Ablation therapy
- 15. Complications • Frequent VPBs are often associated with complications if remained unattended, which include; • Left ventricular dysfunction • Dilated cardiomyopathy • Sustained Ventricular tachycardia • Sudden cardiac arrest