Premature ventricular contraction electrocardiogram: Difference between revisions
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== | ==2017 AHA/ACC/HRS Guideline for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT)<ref name="Al-KhatibStevenson2018">{{cite journal|last1=Al-Khatib|first1=Sana M.|last2=Stevenson|first2=William G.|last3=Ackerman|first3=Michael J.|last4=Bryant|first4=William J.|last5=Callans|first5=David J.|last6=Curtis|first6=Anne B.|last7=Deal|first7=Barbara J.|last8=Dickfeld|first8=Timm|last9=Field|first9=Michael E.|last10=Fonarow|first10=Gregg C.|last11=Gillis|first11=Anne M.|last12=Granger|first12=Christopher B.|last13=Hammill|first13=Stephen C.|last14=Hlatky|first14=Mark A.|last15=Joglar|first15=José A.|last16=Kay|first16=G. Neal|last17=Matlock|first17=Daniel D.|last18=Myerburg|first18=Robert J.|last19=Page|first19=Richard L.|title=2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death|journal=Circulation|volume=138|issue=13|year=2018|issn=0009-7322|doi=10.1161/CIR.0000000000000549}}</ref>== | ||
=== Recommendations for | === Recommendations for 12-lead ECG and Exercise Testing === | ||
{|class="wikitable" | {|class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' | | bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' In patients with VA symptoms associated with exertion, suspected ischemic heart disease, or catecholaminergic polymorphic ventricular tachycardia, exercise treadmill testing is useful to assess for exercise-induced VA ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B-NR]])''.<ref name="ElhendyChandrasekaran2002">{{cite journal|last1=Elhendy|first1=Abdou|last2=Chandrasekaran|first2=Krishnaswamy|last3=Gersh|first3=Bernard J|last4=Mahoney|first4=Douglas|last5=Burger|first5=Kelli N|last6=Pellikka|first6=Patricia A|title=Functional and prognostic significance of exercise-induced ventricular arrhythmias in patients with suspected coronary artery disease|journal=The American Journal of Cardiology|volume=90|issue=2|year=2002|pages=95–100|issn=00029149|doi=10.1016/S0002-9149(02)02428-1}}</ref><ref name="Grady1998">{{cite journal|last1=Grady|first1=Thomas A.|title=Prognostic Significance of Exercise-Induced Left Bundle-Branch Block|journal=JAMA|volume=279|issue=2|year=1998|pages=153|issn=0098-7484|doi=10.1001/jama.279.2.153}}</ref> | ||
'''2.''' In patients with suspected or documented VA, a 12-lead ECG should be obtained in sinus rhythm to look for evidence of heart disease ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B-NR]])''.<ref name="Pérez-RodonMartínez-Alday2014">{{cite journal|last1=Pérez-Rodon|first1=Jordi|last2=Martínez-Alday|first2=Jesus|last3=Barón-Esquivias|first3=Gonzalo|last4=Martín|first4=Alfonso|last5=García-Civera|first5=Roberto|last6=del Arco|first6=Carmen|last7=Cano-Gonzalez|first7=Alicia|last8=Moya-Mitjans|first8=Àngel|title=Prognostic value of the electrocardiogram in patients with syncope: Data from the Group for Syncope Study in the Emergency Room (GESINUR)|journal=Heart Rhythm|volume=11|issue=11|year=2014|pages=2035–2044|issn=15475271|doi=10.1016/j.hrthm.2014.06.037}}</ref><nowiki/> | |||
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Revision as of 22:53, 15 April 2020
Premature ventricular contraction Microchapters |
Differentiating Premature Ventricular Contraction from other Disorders |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2]
Overview
When looking at an electrocardiograph, premature ventricular contractions are easily spotted and therefore a definitive diagnosis can be made. The QRS and T waves look very different to normal readings. The spacing between the PVC and the preceding QRS wave is a lot shorter than usual and the time between the PVC and the proceeding QRS is a lot longer. However, the time between the preceding and proceeding QRS waves stays the same as normal due to the compensatory pause.
Electrocardiogram
- The beats are premature in relation to the expected beat of the basic rhythm.
- Ectopic beats from the same focus tend to have a constant coupling interval (the interval between the ectopic beat and the preceding beat of the basic sinus rhythm).
- They do not vary from each other by more than 0.08 seconds if the focus is the same.
- PVCs with the same morphology but with a varying coupling interval should make one suspect a parasystolic mechanism.
- A longer RR interval is followed by a relatively longer coupling interval.
- The QRS complex is abnormal in duration and configuration. There are secondary ST segment and T wave changes. The morphology of the QRS may vary in the same patient.
- There is usually a full compensatory pause following the PVC.
- The sum of the RR intervals that precede and follow the ectopic beat (or the RR interval that contains the PVC) equals two RR intervals of the sinus beats.
- Because of sinus arrhythmia, the RR interval that contains the PVC may not be exactly twice the duration of the RR interval of the adjacent sinus beat, even though a full compensatory pause does exist).
- Retrograde capture may or may not occur.
- They may occur in various frequency and distribution patterns such as bigeminy, trigeminy (occurrence of a PVC every third beat), quadrigeminy (occurrence of a PVC every fourth beat), and couplets (two ventricular premature complexes in a row). These are called complex PVCs.
- Occasionally PVCs may be interpolated:
2017 AHA/ACC/HRS Guideline for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (DO NOT EDIT)[3]
Recommendations for 12-lead ECG and Exercise Testing
Class I |
1. In patients with VA symptoms associated with exertion, suspected ischemic heart disease, or catecholaminergic polymorphic ventricular tachycardia, exercise treadmill testing is useful to assess for exercise-induced VA (Level of Evidence: B-NR).[4][5]
2. In patients with suspected or documented VA, a 12-lead ECG should be obtained in sinus rhythm to look for evidence of heart disease (Level of Evidence: B-NR).[6] |
References
- ↑ Chou's Electrocardiography in Clinical Practice Third Edition, pp. 398-409.
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:194 ISBN 1591032016
- ↑ Al-Khatib, Sana M.; Stevenson, William G.; Ackerman, Michael J.; Bryant, William J.; Callans, David J.; Curtis, Anne B.; Deal, Barbara J.; Dickfeld, Timm; Field, Michael E.; Fonarow, Gregg C.; Gillis, Anne M.; Granger, Christopher B.; Hammill, Stephen C.; Hlatky, Mark A.; Joglar, José A.; Kay, G. Neal; Matlock, Daniel D.; Myerburg, Robert J.; Page, Richard L. (2018). "2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death". Circulation. 138 (13). doi:10.1161/CIR.0000000000000549. ISSN 0009-7322.
- ↑ Elhendy, Abdou; Chandrasekaran, Krishnaswamy; Gersh, Bernard J; Mahoney, Douglas; Burger, Kelli N; Pellikka, Patricia A (2002). "Functional and prognostic significance of exercise-induced ventricular arrhythmias in patients with suspected coronary artery disease". The American Journal of Cardiology. 90 (2): 95–100. doi:10.1016/S0002-9149(02)02428-1. ISSN 0002-9149.
- ↑ Grady, Thomas A. (1998). "Prognostic Significance of Exercise-Induced Left Bundle-Branch Block". JAMA. 279 (2): 153. doi:10.1001/jama.279.2.153. ISSN 0098-7484.
- ↑ Pérez-Rodon, Jordi; Martínez-Alday, Jesus; Barón-Esquivias, Gonzalo; Martín, Alfonso; García-Civera, Roberto; del Arco, Carmen; Cano-Gonzalez, Alicia; Moya-Mitjans, Àngel (2014). "Prognostic value of the electrocardiogram in patients with syncope: Data from the Group for Syncope Study in the Emergency Room (GESINUR)". Heart Rhythm. 11 (11): 2035–2044. doi:10.1016/j.hrthm.2014.06.037. ISSN 1547-5271.