ECG facts made incredibly quick by M. Eckman, et. al.,

By M. Eckman, et. al.,

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Multiform PVCs may indicate severe heart disease or digoxin toxicity. qxd 5/13/09 12:17 PM Page 53 53 Patterns of potentially dangerous PVCs (continued) Bigeminy and trigeminy PVCs that occur every other beat (bigeminy) or every third beat (trigeminy) can result in VT or VF. The shaded areas on the strip shown above illustrate ventricular bigeminy. R-on-T phenomenon In R-on-T phenomenon, a PVC occurs so early that it falls on the T wave of the preceding beat (see shaded area on strip above). Because the cells haven’t fully repolarized, VT or VF can result.

Watch for evidence of hemodynamic instability, such as hypotension and changes in mental status. qxd 5/13/09 12:16 PM Page 43 43 Premature junctional contractions (continued) What causes them What to do • CAD • COPD • Digoxin toxicity • Electrolyte imbalances • Heart failure • Hyperthyroidism • Inferior-wall MI • Inflammatory changes in the AV junction after heart surgery • Myocardial ischemia • Pericarditis • Stress • Triggers (alcohol, caffeine, nicotine) • Valvular heart disease What to look for • Usually no symptoms • Possible feeling of palpitations or skipped beats • Hypotension if PJCs are frequent enough Junc • Monitor cardiac rhythm for frequent PJCs; may indicate junctional irritability and can lead to more serious arrhythmia such as junctional tachycardia.

Observe closely for development of more frequent PVCs or more dangerous PVC patterns. • Teach family members how to activate EMS and perform CPR if the patient will be taking antiarrhythmic drugs after discharge. qxd 5/13/09 12:17 PM Page 52 Vent Patterns of potentially dangerous PVCs Some PVCs are more dangerous than others. Here are some potentially dangerous ones. Paired PVCs Two PVCs in a row, called paired PVCs or a ventricular couplet (see shaded areas on strip above), can produce VT because the second contrac- tion usually meets refractory tissue.

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