Idioventricular rhythm: Difference between revisions

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Revision as of 23:54, 27 August 2013

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Synonyms and keywords: IVR

Overview

Normally, the SA node is responsible for triggering each heart beat that results in ventricular contraction. However, if the ventricle does not receive triggering signals at a rate high enough, the ventricular myocardium itself becomes the pacemaker or escape rhythm. This is called idioventricular rhythm.

Pathophysiology

Idioventricular rhythm originates in the ventricular area and the depolarization wave spreads either partially through the electrical conduction system or completely via direct cell-to-cell transmission. Idioventricular rhythm can occur as an escape rhythm, or as an increased automaticity of a single ventricular ectopic pacemaker. This increased automaticity may lead to rates that are faster than the intrinsic rate of the upper pacemakers. The intrinsic rate in idioventricular rhythm is most commonly between 30 and 50 BPM, but the rhythm can be anywhere from 20 to 50 BPM. The idioventricular complexes will have the morphological characteristics of the ventricular escape complex, two ventricular escape complexes, two ventricular escape complexes with associated AV dissociation or ectopic ventricular complexes.

Causes

Life Threatening Causes

Idioventricular rhythm is a life-threatening condition and must be treated as such irrespective of the causes. Life-threatening conditions can result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular	Acute coronary syndrome, acute rheumatic fever, Andersen cardiodysrhythmic periodic paralysis, Brugada syndrome, cardiac tumor, complete heart block, congenital heart disease, congestive heart failure, dilated cardiomyopathy, hypertensive heart disease, hypertrophic cardiomyopathy, ischemic heart disease, Jervell and Lange-Nielsen syndrome, Lev's disease, long QT syndrome, myocardial bridging, myocardial infarction, myocarditis, NSTEMI, pericarditis, Romano-Ward syndrome, STEMI, Timothy syndrome, valvular heart disease
Chemical/Poisoning	Carbamate poisoning, organophosphate poisoning, parathion poisoning
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Acetylcholine, amiodarone, anthracyclines, beta-blockers, calcium channel blockers, cholinesterase inhibitors, daunorubicin, digitalis, doxorubicin, edrophonium, epirubicin, idarubicin, neostigmine, procainamide, propafenone, propofol, pyridostigmine, quinidine, tramadol
Ear Nose Throat	No underlying causes
Endocrine	Diabetic ketoacidosis, hyperthyroidism, profound hypothyroidism
Environmental	Hypothermia
Gastroenterologic	No underlying causes
Genetic	Andersen cardiodysrhythmic periodic paralysis, Brugada syndrome, congenital heart block, congenital heart disease, Emery-Dreifuss muscular dystrophy, Jervell and Lange-Nielsen syndrome, Kearns-Sayre syndrome, limb-girdle muscular dystrophy type 1B (LGMD1B), muscular dystrophy, myotonic dystrophy, Romano-Ward syndrome, Timothy syndrome
Hematologic	No underlying causes
Iatrogenic	Cardiac catheterization, cardiac resynchronization therapy, cardiac transplantation, coronary artery bypass grafting, heart surgery, hypertrophic cardiomyopathy alcohol septal ablation, infraclavicular brachial plexus block
Infectious Disease	Acute rheumatic fever, myocarditis, neonatal lupus erythematosus, pericarditis, septic shock
Musculoskeletal/Orthopedic	Muscular dystrophy, myotonic dystrophy, Timothy syndrome
Neurologic	No underlying causes
Nutritional/Metabolic	Hypermagnesemia, hypocalcemia, metabolic acidosis
Obstetric/Gynecologic	No underlying causes
Oncologic	Cardiac tumor
Ophthalmologic	No underlying causes
Overdose/Toxicity	Acetylcholine, amiodarone, anthracyclines, cholinesterase inhibitors, propofol, quinidine, tramadol
Psychiatric	Takotsubo cardiomyopathy, severe anorexia nervosa
Pulmonary	Hypoxia
Renal/Electrolyte	Hyperkalemia, renal failure
Rheumatology/Immunology/Allergy	Acute rheumatic fever
Sexual	No underlying causes
Trauma	Myocardial contusion, severe brain injury
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

Differentiating Idioventricular Rhythm from other Diseases

Below is a Venn diagram to illustrate some of the similarities and disparities between different ventricular escape rhythms.

References

Template:WH Template:WS

@@ Line 36: / Line 36: @@
 {|style="width:80%; height:100px" border="1"
 |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
-|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
+|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Acute coronary syndrome]], [[acute rheumatic fever]], [[Andersen cardiodysrhythmic periodic paralysis]], [[Brugada syndrome]], [[cardiac tumor]], [[complete heart block]], [[congenital heart disease]], [[congestive heart failure]], [[dilated cardiomyopathy]], [[hypertensive heart disease]], [[hypertrophic cardiomyopathy]], [[ischemic heart disease]], [[Jervell and Lange-Nielsen syndrome]], [[Lev's disease]], [[long QT syndrome]], [[myocardial bridging]], [[myocardial infarction]], [[myocarditis]], [[NSTEMI]], [[pericarditis]], [[Romano-Ward syndrome]], [[STEMI]], [[Timothy syndrome]], [[valvular heart disease]]
 |-
 |bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[carbamate|Carbamate poisoning]], [[organophosphate|organophosphate poisoning]], [[parathion|parathion poisoning]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 51: / Line 51: @@
 |-bgcolor="LightSteelBlue"
 | '''Drug Side Effect'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Acetylcholine]], [[amiodarone]], [[anthracyclines]], [[beta-blockers]], [[calcium channel blockers]], [[cholinesterase inhibitors]], [[daunorubicin]], [[digitalis]], [[doxorubicin]], [[edrophonium]], [[epirubicin]], [[idarubicin]], [[neostigmine]], [[procainamide]], [[propafenone]], [[propofol]], [[pyridostigmine]], [[quinidine]], [[tramadol]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 59: / Line 59: @@
 |-bgcolor="LightSteelBlue"
 | '''Endocrine'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Diabetic ketoacidosis]], [[hyperthyroidism]], [[hypothyroidism|profound hypothyroidism]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Environmental'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Hypothermia]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 71: / Line 71: @@
 |-bgcolor="LightSteelBlue"
 | '''Genetic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Andersen cardiodysrhythmic periodic paralysis]], [[Brugada syndrome]], [[congenital heart block]], [[congenital heart disease]], [[Emery-Dreifuss muscular dystrophy]], [[Jervell and Lange-Nielsen syndrome]], [[Kearns-Sayre syndrome]], [[Limb-girdle muscular dystrophy|limb-girdle muscular dystrophy type 1B (LGMD1B)]], [[muscular dystrophy]], [[myotonic dystrophy]], [[Romano-Ward syndrome]], [[Timothy syndrome]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 79: / Line 79: @@
 |-bgcolor="LightSteelBlue"
 | '''Iatrogenic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Cardiac catheterization]], [[cardiac resynchronization therapy]], [[cardiac transplantation]], [[coronary artery bypass grafting]], [[heart surgery]], [[hypertrophic cardiomyopathy alcohol septal ablation]], [[regional anesthesia|infraclavicular brachial plexus block]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Infectious Disease'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Acute rheumatic fever]], [[myocarditis]], [[neonatal lupus erythematosus]], [[pericarditis]], [[septic shock]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Musculoskeletal/Orthopedic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Muscular dystrophy]], [[myotonic dystrophy]], [[Timothy syndrome]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 95: / Line 95: @@
 |-bgcolor="LightSteelBlue"
 | '''Nutritional/Metabolic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Hypermagnesemia]], [[hypocalcemia]], [[metabolic acidosis]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 103: / Line 103: @@
 |-bgcolor="LightSteelBlue"
 | '''Oncologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Cardiac tumor]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 111: / Line 111: @@
 |-bgcolor="LightSteelBlue"
 | '''Overdose/Toxicity'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Acetylcholine]], [[amiodarone]], [[anthracyclines]], [[cholinesterase inhibitors]], [[propofol]], [[quinidine]], [[tramadol]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Psychiatric'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Takotsubo cardiomyopathy]], [[anorexia nervosa|severe anorexia nervosa]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Pulmonary'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Hypoxia]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Renal/Electrolyte'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Hyperkalemia]], [[renal failure]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Rheumatology/Immunology/Allergy'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Acute rheumatic fever]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 135: / Line 135: @@
 |-bgcolor="LightSteelBlue"
 | '''Trauma'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Myocardial contusion]], [[brain damage|severe brain injury]]
 |-
 |-bgcolor="LightSteelBlue"