Accelerated idioventricular rhythm: Difference between revisions
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==Background== | |||
*Results when rate of an ectopic ventricular pacemaker exceeds sinus node. | |||
Usually benign,self limiting | *Usually benign,self limiting | ||
===Causes=== | ===Causes=== | ||
#Reperfusion phase of acute myocardial infarction (= most common cause) | #Reperfusion phase of [[acute myocardial infarction]] (= most common cause) | ||
#Beta-sympathomimetics (isoprenaline or adrenaline) | #Beta-sympathomimetics (isoprenaline or adrenaline) | ||
#Drug toxicity, especially digoxin, cocaine and volatile anaesthetics such as desflurane | #Drug toxicity, especially [[digoxin]], [[cocaine]] and volatile anaesthetics such as desflurane | ||
#Electrolyte abnormalities | #[[Electrolyte abnormalities]] | ||
#Cardiomyopathy, congenital heart disease, myocarditis | #[[Cardiomyopathy]], [[congenital heart disease]], [[myocarditis]] | ||
#Return of spontaneous circulation (ROSC) following cardiac arrest | #Return of spontaneous circulation ([[ROSC]]) following [[cardiac arrest]] | ||
#Athletic heart | #Athletic heart | ||
==Clinical Features== | |||
==Differential Diagnosis== | |||
==Diagnosis== | |||
===ECG features=== | ===ECG features=== | ||
#Regular rhythm. | #Regular rhythm. | ||
| Line 16: | Line 23: | ||
#QRS complexes >120ms. | #QRS complexes >120ms. | ||
#Fusion and capture beats. | #Fusion and capture beats. | ||
==Management== | |||
#AIVR is a benign rhythm in most settings and does not usually require treatment. | #AIVR is a benign rhythm in most settings and does not usually require treatment. | ||
#Self limiting and resolves when sinus rate exceeds that of the ventricular foci. | #Self limiting and resolves when sinus rate exceeds that of the ventricular foci. | ||
| Line 22: | Line 30: | ||
#Treat the underlying cause: e.g. correct electrolytes, restore myocardial perfusion. | #Treat the underlying cause: e.g. correct electrolytes, restore myocardial perfusion. | ||
#Patients with low-cardiac-output states (e.g. severe biventricular failure) may benefit from restoration of AV synchrony to restore atrial kick – in this case atropine may be trialled to increase sinus rate and AV conduction. | #Patients with low-cardiac-output states (e.g. severe biventricular failure) may benefit from restoration of AV synchrony to restore atrial kick – in this case atropine may be trialled to increase sinus rate and AV conduction. | ||
=== | |||
http://lifeinthefastlane.com/ecg-library/aivr/ | ==Disposition== | ||
==See Also== | |||
==External Links== | |||
*http://lifeinthefastlane.com/ecg-library/aivr/ | |||
==References== | |||
<references/> | |||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Revision as of 04:02, 9 June 2016
Background
- Results when rate of an ectopic ventricular pacemaker exceeds sinus node.
- Usually benign,self limiting
Causes
- Reperfusion phase of acute myocardial infarction (= most common cause)
- Beta-sympathomimetics (isoprenaline or adrenaline)
- Drug toxicity, especially digoxin, cocaine and volatile anaesthetics such as desflurane
- Electrolyte abnormalities
- Cardiomyopathy, congenital heart disease, myocarditis
- Return of spontaneous circulation (ROSC) following cardiac arrest
- Athletic heart
Clinical Features
Differential Diagnosis
Diagnosis
ECG features
- Regular rhythm.
- Rate 50-110 bpm.
- Three or more ventricular complexes.
- QRS complexes >120ms.
- Fusion and capture beats.
Management
- AIVR is a benign rhythm in most settings and does not usually require treatment.
- Self limiting and resolves when sinus rate exceeds that of the ventricular foci.
- Anti-arrhythmics may cause precipitous haemodynamic deterioration and should be avoided.
- Treat the underlying cause: e.g. correct electrolytes, restore myocardial perfusion.
- Patients with low-cardiac-output states (e.g. severe biventricular failure) may benefit from restoration of AV synchrony to restore atrial kick – in this case atropine may be trialled to increase sinus rate and AV conduction.