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Lesson 15 of 21 · Rhythm Recognition

Ventricular Rhythms

Impulses that arise in the ventricles bypass the His–Purkinje system, so the QRS is wide and bizarre with a discordant T wave.

01PVCs

II
PVC: early, wide beat with no P and a full compensatory pause.
II
Ventricular bigeminy: every other beat is a PVC.

02Slow ventricular rhythms

II
Idioventricular: 20–40.
II
Accelerated idioventricular (AIVR): 50–110. Classic reperfusion rhythm after PCI or lysis; benign.

Clinical pearl. Never suppress a ventricular escape rhythm with lidocaine or amiodarone: it may be the only thing keeping the patient alive.

03Lethal rhythms

II
Monomorphic VT.
II
Torsades de pointes: twisting polymorphic VT.
II
Ventricular fibrillation.

Key takeaways

  • Wide + no P = ventricular origin
  • AIVR after reperfusion is benign
  • Pulseless VT/VF = defibrillate