Question

1. Explain the unique ECG characteristics of premature ventricular contractions -

2. Explain the pharmacological treatments to manage the patient experiencing your dysrhythmia-

3. Explain the non- pharmacological treatments to manage the patient experiencing your dysrhythmia-

Answer 1

Heart has four chambers that pump blood. The top chambers are called atria, and bottom chambers are called ventricles. Heartbeats are triggered by electrical charges that cause the four chambers to squeeze and pump blood. PVCs are extra heartbeats that start in one of the ventricles.

Premature Ventricular Contractions are common arrhythmias in patients with structural abnormalities of heart .In most cases it is benign and cause symptoms like dyspnea,fatigue and palpitations .

Premature Ventricular Contractions are characterized by premature and bizarrely shaped QRS complexes that are unusually long (typically >120 msec) and appear wide on the electrocardiogram (ECG). These complexes are not preceded by a P wave, and the T wave is usually large and oriented in a direction opposite the major deflection of the QRS.PVC occurs earlier than the regular normally conducted beat.

PVCs become more of a concern if they happen frequently. “If more than 10% to 15% of a person's heartbeats in 24 hours are PVCs, that's excessive,” Bentz said. The more PVCs occur, the more they can potentially cause a condition called cardiomyopathy (a weakened heart muscle).

Other names of premature ventricular contractions include

• Premature ventricular complexes
• Ventricular premature beats
• Extrasystoles

Premature ventricular contractions are frequently encountered and management is determined by symptoms, precipitating factors, and the presence of underlying cardiac disease.Occasional PVCs with no other symptoms and no underlying heart disease or structural problems, no treatment is necessary.No drug is approved by FDA for PVCs.But following are used

Beta blockers are safe and effective drugs that are often used to treat heart arrhythmias.Cardioselective beta-blockers including atenolol, betaxolol, metoprolol, and nadolol should be considered in these patients to reduce PVC burden

In ablation therapy, Radiofrequency waves are used to vaporize tiny amounts of tissue in the area of the heart where the extra beat originates. This is a minimally invasive procedure that is reserved for patients who cannot tolerate beta blockers, in whom medication is ineffective or who cannot comply with long-term drug therapy.

Amiodarone class III antiarrhythmic agent, can be used if beta-blockers or CCB are unsuccessful in suppressing the symptomatic PVCs. Alternatively, non-dihydropyridine calcium channel blockers (CCB) can also be used .

Life style changes help in controlling PVC.

1. Eat a heart-healthy diet.
2. Get enough exercise and maintain a healthy weight.
3. Eliminate too much alcohol, caffeine or tea, which can trigger PVCs.
4. Avoid too much stress and anxiety, which can also trigger PVCs.
5. Get treatment for other medical conditions, like high blood pressure.