1. CARDIAC ARRHYTHMIAS ORIGINATING IN THE VENTRICLES Commonly caused by an acute myocardial infarction or myocardial ischaemia Other causes include cardiac surgery, valvular disease, left ventricular failure, cardiomyopathy, ventricular aneurysm, myocarditis, electrolyte and pH derangements, hypoxaemia, hypoglycaemia 2. VENTRICULAR ECTOPICS (VE) Image: www.skills4nurses.com QRS rate: determined by the underlying rhythm QRS width: VE will be wide and bizarre with chaniging amplitude, morphology and deflection. Morphology differs from that of the QRS complexes associated with underlying rhythm. ST segment usually slopes in a direction opposite to the QRS deflection; Pwaves: usually none associated with VEs. Not possible to determine the relationship between P waves and VEs. 3. VENTRICULAR ECTOPICS (VE) different types Uniform or unifocal VES: VEs of the same morphology Image: www.skills4nurses.com Multiform: 2 or more VEs of distinctly of different morphology Image: www.skills4nurses.com R on T : When VE lands on T wave Ventricular bigeminy: VE after every sinus beat Ventricular trigeminy: VE after every second beat Couplets: pairs of VE Salvos: three or more consecutive VEs. 4. Ventricular Tachycardia (VT) If there are 3 or more successive ventricular ectopics at a rate >120/min, it is classed as VT. Sustained VT lasting more than 30 seconds Non-sustained VT less than 30 seconds. QRS width wide and bizarre Unconscious VT is a shockable rhythm Monomorphic VT Image: floarnurse-mike.blogspot.com 5. TORSADES DE POINTES It is a form of ventricular tachycardia Name refers to twisting around point So rhythm looks like a twisted ribbon. Wave like pattern to QRS complex. Magnesium is the treatment of choice. 6. Ventricular Fibrillation No recognisable QRS complex Chaotic waveform Low amplitude waveforms Disorganised undulation about the baseline Very fatal as the patient becomes pulseless and unconscious due to lack of cardiac output VF is a shockable rhythm and requires immediate defibrillation Image: www.medicine-on-line.com