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Premature ventricular contractionscomplexes pvcs

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Premature Ventricular Contractions/Complexes (PVC’s)Increased irritability of ventricular cells; early ventricular beats, followed by a pauseMay be unifocal (from 1 focus), or multifocalMay occur in predictable patterns, or consecutive (Ex: 2 NSR, 1 PVC, 2 NSR, 1 PVC)55
Exam 1: Adult Health ll—CardiovascularChapters 26-32Random ones are usually insignificant; can be very serious depending upon number and pattern(decreased cardiac output)Caused by MI, CHF, hypoxia, meds, stress, nicotine, caffeine, alcohol, trauma, anesthesia, surgery,etc.Eliminate cause; oxygen; amiodarone (Cordarone), Lidocaine, procainamide (Pronestyl); electrolytesprnNow the problem is with the ventricles.The atria are functioning normally, and therefore the P wavesshould look normal.But now the ventricle is contracting before we would expect it to.That meansthere is some irritability in it, or something is stimulating it to do so.Can also be due to an MI, and that ventricular muscle is just very unstable.Treatment depends solely upon how many there are (usually more than 5-6 per minute need treatment),are they coming from 1 or multiple foci (do they look different from each other, or all the same), and thepatient symptoms.Is cardiac output compromised?Are there signs the ventricle is very unstable?Can progress to V-tach or V-fib, and we don’t want that!PVC’sA - NSR with 2 unifocal PVC’s.B – NSR with 2 multifocal PVC’s, 1 with a negative deflection and 1 with a positive deflection.This ismuch more serious, because they are originating in 2 different places in the ventricle.Would probablywant to treat these.C – NSR with 3 consecutive PVC’s, which is considered non-sustained (not continued) V-tach.Then hadanother isolated PVC from the same foci.This would also require treatment to prevent furtherproblems.Ventricular Tachycardia (V Tach)Patient may/may not have a pulse with V TachMeds: lidocaine, pronestil, oxygenOften precedes ventricular fibrillationRepetitive firing of irritable ventricular foci, 140-180+ bpm; symptoms depend upon the rate and COP waves seldom seenMay be self-limiting of a few beats, or sustained.If not corrected, client will quickly deteriorate56
Exam 1: Adult Health ll—CardiovascularChapters 26-32Caused by MI, other heart diseases, low K+, low Mg++, drug toxicity, hypotension, ventricularaneurysmCardioversion/defibrillation, CPR if neededMonitor closely for continuing PVC’s; may need AICDp. 729Now we have trouble.This must be stopped ASAP because cardiac output is very low, and it canprogress to V-fib.Seldom see P waves, and if they are present they aren’t conducting the impulses anyway.Whether or not this patient is defibrillated depends upon their tolerance.If lose consciousness and BPdrops, they will be shocked.If remain alert, give Lidocaine IVP and hope it converts.But get the crashcart handy!

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Term
Fall
Professor
N/A
Tags
Cardiology, Atherosclerosis, HTN treatment

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