Lesson V (cont)- Ventricular Arrhythmias

qR morphology suggests ventricular ectopy unless a previous

anteroseptal MI or unless the patient's normal V1 QRS complex has
a QS morphology (i.e., no initial r-wave)!

If the QRS in V1 is mostly negative the following possibilities exist:

Rapid downstroke of the S wave with or without a preceding

"thin" r wave suggests LBBB aberrancy almost always!

Fat" r wave (0.04s) or notch/slur on downstroke of S wave or

>0.06s delay from QRS onset to nadir of S wave almost always
suggests ventricular ectopy!

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In the above ECG the wide premature QRS is a

PVC because of the >0.06s delay from onset of
the QRS to the nadir of the S wave
(approximately 0.08s).

Another QRS morphology clue from Lead V6:

If the wide QRS morphology is predominately negative in

direction in lead V6, then it's most likely ventricular ectopy
(assuming V6 is accurately placed in mid axillary line)!

The timing of the premature wide QRS complex is also important because
aberrantly conducted QRS complexes only occur early in the cardiac cycle
during the refractory period of one of the conduction branches. Therefore, late
premature wide QRS complexes (after the T wave, for example) are most often
ventricular ectopic in origin.

3. Ventricular Tachycardia

Descriptors to consider when considering ventricular tachycardia:

Sustained (lasting >30 sec) vs. nonsustained

Monomorphic (uniform morphology) vs. polymorphic vs. Torsade-de-pointes

http://library.med.utah.edu/kw/ecg/ecg_outline/Lesson5/ventricular.html (6 of 10) [5/11/2006 9:39:47 AM]