Ventricular autonomic rhythm

Introduction Ventricular autonomous rhythm is one of the important problems of arrhythmia in cardiac rhythm. One of the important problems of complete atrioventricular block caused by bilateral bundle branch block is conduction by bilateral bundle branch. Complete atrioventricular block caused by blockade.

Cause

The most common cause of ventricular autonomic rhythm is complete atrioventricular block caused by bilateral bundle branch block.

Ventricular escape is more than 3 consecutive times and can be called ventricular rhythm.

Ventricular rhythm ventricular rate is slow, 35-40 times per minute. The P wave is not related to the QRS complex, or the P wave is not found.

an examination

Related inspection

EEG examination electrocardiogram

Most of the diagnosis of arrhythmia nature depends on the electrocardiogram, but a considerable number of patients can make a preliminary diagnosis based on medical history and signs. Detailed questioning of heart rate, rhythm (regular or not, feeling of missedness, etc.) at the onset, onset and duration of onset. The presence or absence of hypotension, fainting or near fainting, convulsions, angina or heart failure, as well as the causes, frequency and treatment of previous episodes, can help determine the nature of arrhythmia.

Physical examination at the time of onset should focus on the nature of the arrhythmia and the effect of arrhythmia on the state of blood flow. Auscultation of heart sounds to understand the speed, slowness and regularity of ventricular beat rate, combined with the atrial activity reflected by jugular pulsation, helps to make a preliminary differential diagnosis of arrhythmia. The heart rate is slow (<60 beats/min) and the regular sinus bradycardia, 2:1 or 3:1 or complete atrioventricular block, or sinus block, and atrioventricular junction are more common. Rapid heart rate (>100 beats/min) and regular sinus tachycardia, supraventricular tachycardia, atrial flutter or atrial tachycardia with 2:1 atrioventricular conduction, or ventricular tachycardia . The sinus tachycardia was less than 160 beats/min, and the atrial flutter was usually fixed at 150 times/min with 2:1 atrioventricular conduction. Premature beats are the most common in irregular heart rhythms. Fast and irregular patients with atrial fibrillation or flutter, atrial tachycardia with irregular atrioventricular block; slow irregularities with atrial fibrillation ( After digitalis treatment, sinus bradycardia with sinus arrhythmia, sinus rhythm with irregular sinus or atrioventricular block is more common. The heart rhythm rules and the first heart sounds vary in intensity (cannon sound), especially with the intermittent increase of jugular vein beat irregularity (cannon wave), suggesting that the atrioventricular septum is more common in complete atrioventricular block or ventricular cardiac motility. Overspeed.

The effect of carotid sinus massage on tachyarrhythmia is helpful in the differential diagnosis of arrhythmia. In order to avoid accidents such as hypotension and cardiac arrest, patients should be treated with electrocardiogram monitoring in the supine position. The elderly should be used with caution and those with cerebrovascular disease should be banned. Each time the carotid sinus is massaged on one side, the duration of one massage is less than 5 seconds, which can reduce the rate of atrial flutter, and can also turn supraventricular tachycardia into sinus rhythm.

Electrocardiogram recording during the onset of arrhythmia is an important basis for the diagnosis of arrhythmia. Longer II or V1 lead records should be included. Pay attention to the P and QRS wave morphology, P-QRS relationship, PP, PR and RR interval, and determine whether the basic heart rhythm is sinus or ectopic. When the chamber is independent, find out the origin of the P-wave and QRS complexes (selection II, aVF, aVR, V1, and V5, V6 leads). When the P wave is not obvious, try to increase the voltage or speed up the paper speed, and make a long record of the lead with obvious P wave. If necessary, the P wave can also be displayed using the esophageal lead or the right atrial electrogram. When the above method is used to consciously search for QRS, ST and T waves but there is still no P wave, consider atrial fibrillation, flutter, heart rate at the atrioventricular junction or atrial pause. The nature of the arrhythmia is finally judged by analyzing the nature and source of the heartbeat early or delayed.

Intermittent physical examination should focus on evidence of hypertension, coronary heart disease, valvular disease, cardiomyopathy, myocarditis and other organic heart disease. Non-invasive and invasive examinations such as conventional electrocardiogram, echocardiography, electrocardiographic exercise stress test, radionuclide imaging, and cardiovascular angiography can help diagnose or rule out organic heart disease.

Differential diagnosis

Supraventricular arrhythmia: rapid supraventricular arrhythmia is a clinically common cardiovascular emergency, including various supraventricular tachycardia and atrial flutter, atrial fibrillation. The clinical treatment measures have been improved, including invasive treatment methods such as vagus nerve stimulation, electric shock cardioversion, drug treatment and radiofrequency ablation, which can basically control all seizures, and many of them can still achieve the goal of radical cure.

Most of the diagnosis of arrhythmia nature depends on the electrocardiogram, but a considerable number of patients can make a preliminary diagnosis based on medical history and signs. Detailed questioning of heart rate, rhythm (regular or not, feeling of missedness, etc.) at the onset, onset and duration of onset. The presence or absence of hypotension, fainting or near fainting, convulsions, angina or heart failure, as well as the causes, frequency and treatment of previous episodes, can help determine the nature of arrhythmia.

Physical examination at the time of onset should focus on the nature of the arrhythmia and the effect of arrhythmia on the state of blood flow. Auscultation of heart sounds to understand the speed, slowness and regularity of ventricular beat rate, combined with the atrial activity reflected by jugular pulsation, helps to make a preliminary differential diagnosis of arrhythmia. The heart rate is slow (<60 beats/min) and the regular sinus bradycardia, 2:1 or 3:1 or complete atrioventricular block, or sinus block, and atrioventricular junction are more common. Rapid heart rate (>100 beats/min) and regular sinus tachycardia, supraventricular tachycardia, atrial flutter or atrial tachycardia with 2:1 atrioventricular conduction, or ventricular tachycardia . The sinus tachycardia was less than 160 beats/min, and the atrial flutter was usually fixed at 150 times/min with 2:1 atrioventricular conduction. Premature beats are the most common in irregular heart rhythms. Fast and irregular patients with atrial fibrillation or flutter, atrial tachycardia with irregular atrioventricular block; slow irregularities with atrial fibrillation ( After digitalis treatment, sinus bradycardia with sinus arrhythmia, sinus rhythm with irregular sinus or atrioventricular block is more common. The heart rhythm rules and the first heart sounds vary in intensity (cannon sound), especially with the intermittent increase of jugular vein beat irregularity (cannon wave), suggesting that the atrioventricular septum is more common in complete atrioventricular block or ventricular cardiac motility. Overspeed.

The effect of carotid sinus massage on tachyarrhythmia is helpful in the differential diagnosis of arrhythmia. In order to avoid accidents such as hypotension and cardiac arrest, patients should be treated with electrocardiogram monitoring in the supine position. The elderly should be used with caution and those with cerebrovascular disease should be banned. Each time the carotid sinus is massaged on one side, the duration of one massage is less than 5 seconds, which can reduce the rate of atrial flutter, and can also turn supraventricular tachycardia into sinus rhythm.

Electrocardiogram recording during the onset of arrhythmia is an important basis for the diagnosis of arrhythmia. Longer II or V1 lead records should be included. Pay attention to the P and QRS wave morphology, P-QRS relationship, PP, PR and RR interval, and determine whether the basic heart rhythm is sinus or ectopic. When the chamber is independent, find out the origin of the P-wave and QRS complexes (selection II, aVF, aVR, V1, and V5, V6 leads). When the P wave is not obvious, try to increase the voltage or speed up the paper speed, and make a long record of the lead with obvious P wave. If necessary, the P wave can also be displayed using the esophageal lead or the right atrial electrogram. When the above method is used to consciously search for QRS, ST and T waves but there is still no P wave, consider atrial fibrillation, flutter, heart rate at the atrioventricular junction or atrial pause. The nature of the arrhythmia is finally judged by analyzing the nature and source of the heartbeat early or delayed.

Intermittent physical examination should focus on evidence of hypertension, coronary heart disease, valvular disease, cardiomyopathy, myocarditis and other organic heart disease. Non-invasive and invasive examinations such as conventional electrocardiogram, echocardiography, electrocardiographic exercise stress test, radionuclide imaging, and cardiovascular angiography can help diagnose or rule out organic heart disease.

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