Unifocal PVCs
Also called premature ventricular contractions, PVCs.
An otherwise sinus rhythm interrupted by early, wide, bizarre complexes with no P wave in front and a T wave pointing opposite the QRS. Every PVC has the same shape, and the pause after each one is fully compensatory.
How to identify Unifocal PVCs
- Rate
- That of the underlying rhythm
- Rhythm
- Regular, interrupted by early beats
- P waves
- None in front of the early beat
- PR interval
- Normal on the sinus beats
- QRS
- Early beats are 0.12 s or wider and bizarre
- Clincher
- Early, wide beats that all look alike, with a T wave pointing opposite the QRS and a compensatory pause.
Rhythms it gets mistaken for
Unifocal PVCs vs Multifocal PVCs
Unifocal PVCs has wide complexes that all look alike. With multifocal PVCs you would see wide early beats of more than one shape.
Unifocal PVCs vs Ventricular bigeminy
Unifocal PVCs has a regular rhythm interrupted by early beats. With bigeminy you would see an early beat after every normal beat.
Unifocal PVCs vs PVC couplet
Unifocal PVCs has a regular rhythm interrupted by early beats. With a PVC couplet you would see two early beats in a row.
Treatment by certification level
Open your level. Treat the patient, not the strip.
Paramedic
Treat the cause and monitor.
- No prophylactic antiarrhythmic for isolated ectopy, even in acute coronary syndrome. Treat the ischemia and watch the rhythm.
- Watch for the patterns that matter: R-on-T, couplets, multiformed, frequent uniform, bigeminy.
AEMT
Pulse present and stable.
- Oxygen only if hypoxic or short of breath, IV access, monitoring.
- Acquire and transmit a 12-lead ECG. Interpreting it is a Paramedic skill.
- Transport and reassess. Request a paramedic if the patient worsens.
EMT
Pulse present: assess and support.
- Treat the patient, not the rhythm name: airway, breathing, circulation, vital signs.
- Oxygen if the SpO2 is under 94%, the patient is short of breath, or shows signs of shock.
- Request ALS and transport promptly. Reassess on the way.
An AED goes only on a patient who is unresponsive, not breathing and pulseless. It cannot feel a pulse, so on a patient with a pulse it can advise a shock that would do harm.