Premature ventricular contraction electrocardiogram: Difference between revisions
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#* Occurs mostly when the NSR is slow and the [[PVC]] is early | #* Occurs mostly when the NSR is slow and the [[PVC]] is early | ||
#* The PR following the [[PVC]] is nearly always prolonged because of concealed retrograde conduction of the ectopic ventricular impulse, which renders the AV junction partially refractory.<ref>Chou's Electrocardiography in Clinical Practice Third Edition, pp. 398-409.</ref> <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:194 ISBN 1591032016</ref> | #* The PR following the [[PVC]] is nearly always prolonged because of concealed retrograde conduction of the ectopic ventricular impulse, which renders the AV junction partially refractory.<ref>Chou's Electrocardiography in Clinical Practice Third Edition, pp. 398-409.</ref> <ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:194 ISBN 1591032016</ref> | ||
==2015 ESC Guidelines on the Diagnosis and Treatment of Pericarditis (DO NOT EDIT)<ref name="AdlerCharron2015">{{cite journal|last1=Adler|first1=Yehuda|last2=Charron|first2=Philippe|last3=Imazio|first3=Massimo|last4=Badano|first4=Luigi|last5=Barón-Esquivias|first5=Gonzalo|last6=Bogaert|first6=Jan|last7=Brucato|first7=Antonio|last8=Gueret|first8=Pascal|last9=Klingel|first9=Karin|last10=Lionis|first10=Christos|last11=Maisch|first11=Bernhard|last12=Mayosi|first12=Bongani|last13=Pavie|first13=Alain|last14=Ristić|first14=Arsen D.|last15=Sabaté Tenas|first15=Manel|last16=Seferovic|first16=Petar|last17=Swedberg|first17=Karl|last18=Tomkowski|first18=Witold|title=2015 ESC Guidelines for the diagnosis and management of pericardial diseases|journal=European Heart Journal|volume=36|issue=42|year=2015|pages=2921–2964|issn=0195-668X|doi=10.1093/eurheartj/ehv318}}</ref>== | |||
=== Recommendations for the management of acute pericarditis === | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LightGreen"|[[ESC Guidelines Classification Scheme#Classification of Recommendations|Class I]] | |||
|- | |||
| bgcolor="LightGreen"|<nowiki></nowiki>'''1.''' [[Hospital]] [[Admission note|admission]] is recommended for high-risk [[patients]] with [[acute pericarditis]] (at least one [[risk factor]]). | |||
'''2.''' [[Outpatient]] management is recommended for low-risk [[patients]] with [[acute pericarditis]]. | |||
'''3.''' Evaluation of response to [[Anti inflammatory medications|anti-inflammatory therapy]] is recommended after 1 week. ''([[ACC AHA Guidelines Classification Scheme#Level of Evidence|Level of Evidence: B]])<ref name="ImazioDemichelis2004">{{cite journal|last1=Imazio|first1=Massimo|last2=Demichelis|first2=Brunella|last3=Parrini|first3=Iris|last4=Giuggia|first4=Marco|last5=Cecchi|first5=Enrico|last6=Gaschino|first6=Gianni|last7=Demarie|first7=Daniela|last8=Ghisio|first8=Aldo|last9=Trinchero|first9=Rita|title=Day-hospital treatment of acute pericarditis|journal=Journal of the American College of Cardiology|volume=43|issue=6|year=2004|pages=1042–1046|issn=07351097|doi=10.1016/j.jacc.2003.09.055}}</ref><ref name="ImazioCecchi2007">{{cite journal|last1=Imazio|first1=Massimo|last2=Cecchi|first2=Enrico|last3=Demichelis|first3=Brunella|last4=Ierna|first4=Salvatore|last5=Demarie|first5=Daniela|last6=Ghisio|first6=Aldo|last7=Pomari|first7=Franco|last8=Coda|first8=Luisella|last9=Belli|first9=Riccardo|last10=Trinchero|first10=Rita|title=Indicators of Poor Prognosis of Acute Pericarditis|journal=Circulation|volume=115|issue=21|year=2007|pages=2739–2744|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.106.662114}}</ref>'' | |||
''<nowiki/>'' | |||
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==References== | ==References== | ||
Revision as of 22:43, 15 April 2020
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Premature ventricular contraction Microchapters |
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Differentiating Premature Ventricular Contraction from other Disorders |
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Diagnosis |
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Treatment |
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Case Studies |
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Premature ventricular contraction electrocardiogram On the Web |
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Premature ventricular contraction electrocardiogram in the news |
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Blogs on Premature ventricular contraction electrocardiogram |
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to Hospitals Treating Premature ventricular contraction electrocardiogram |
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Risk calculators and risk factors for Premature ventricular contraction electrocardiogram |
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:
2015 ESC Guidelines on the Diagnosis and Treatment of Pericarditis (DO NOT EDIT)[3]
Recommendations for the management of acute pericarditis
| Class I |
| 1. Hospital admission is recommended for high-risk patients with acute pericarditis (at least one risk factor).
2. Outpatient management is recommended for low-risk patients with acute pericarditis. 3. Evaluation of response to anti-inflammatory therapy is recommended after 1 week. (Level of Evidence: B)[4][5]
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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
- ↑ Adler, Yehuda; Charron, Philippe; Imazio, Massimo; Badano, Luigi; Barón-Esquivias, Gonzalo; Bogaert, Jan; Brucato, Antonio; Gueret, Pascal; Klingel, Karin; Lionis, Christos; Maisch, Bernhard; Mayosi, Bongani; Pavie, Alain; Ristić, Arsen D.; Sabaté Tenas, Manel; Seferovic, Petar; Swedberg, Karl; Tomkowski, Witold (2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases". European Heart Journal. 36 (42): 2921–2964. doi:10.1093/eurheartj/ehv318. ISSN 0195-668X.
- ↑ Imazio, Massimo; Demichelis, Brunella; Parrini, Iris; Giuggia, Marco; Cecchi, Enrico; Gaschino, Gianni; Demarie, Daniela; Ghisio, Aldo; Trinchero, Rita (2004). "Day-hospital treatment of acute pericarditis". Journal of the American College of Cardiology. 43 (6): 1042–1046. doi:10.1016/j.jacc.2003.09.055. ISSN 0735-1097.
- ↑ Imazio, Massimo; Cecchi, Enrico; Demichelis, Brunella; Ierna, Salvatore; Demarie, Daniela; Ghisio, Aldo; Pomari, Franco; Coda, Luisella; Belli, Riccardo; Trinchero, Rita (2007). "Indicators of Poor Prognosis of Acute Pericarditis". Circulation. 115 (21): 2739–2744. doi:10.1161/CIRCULATIONAHA.106.662114. ISSN 0009-7322.