PAC or PVC?

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firemedic31075

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Medic partner said it was a PAC, after quizzing me on it for a few minutes. Looks like a PVC in 3 to me, but then again I'm still learning.
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I think your partner needs to brush up on his EKG's.
 
mycrofft

mycrofft

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Rid wins..."Treat the patient".

By the way, not that uncommon for kids to be abusing epehdra, caffeine, and allied chemicals in "energy" products, OTC drugs, and even street drugs containing good or bad crank (meth). Most get over it. Some get hooked. Some find out they have WPW Syndrome.
 
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firemedic31075

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Not at all. It could well be a PAC with aberrent (abnormal) conduction. You can technically have PSVT with aberrant conduction that looks for all the world like ventricular tachycardia. Just because it is wide, does not mean it's ventricular in origin.
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True, but look at the ST segment and T wave. Usually with a PVC the T wave will deflect the opposite direction of the complex.
 
MSDeltaFlt

MSDeltaFlt

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Ridryder911 said:
PAC's usually does not have compensatory pause as well as such as a wide QRS. Abberant PAC in set pattern as well is not the usual. I am surprised that you would request a 12 to determine a PVC or not...

R/r 911
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I've been off of this thread for a while so I apologize for the reply delay. The reason I would like to see a 12 Lead to determine the origin of this bizarre complex lies with the appearance of what looks like a possible P wave right before the complex in Lead I. If all I had was Lead II or III, then I'd say yes. It's a PVC. Lead I, however, says "maybe, maybe not".

Reality check. Let's step back and look at the big picture here. It's only one complex. Q: What does this have to do with the price of milk? A: Absolutely nothing. Translation: It's benign. Even if I'm wrong on the interpretation. It's not worth losing sleep over.

Just my humble and respectful thoughts to you sir.
 
Ridryder911

Ridryder911

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MSDeltaFlt said:
Reality check. Let's step back and look at the big picture here. It's only one complex. Q: What does this have to do with the price of milk? A: Absolutely nothing. Translation: It's benign. Even if I'm wrong on the interpretation. It's not worth losing sleep over.

Just my humble and respectful thoughts to you sir.
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Oh, c'mon no Lido or better yet no Amiadorone?... C'mon I went all 5 months to Paramedic school! I gotta give something! ..... :D
 
MSDeltaFlt

MSDeltaFlt

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Ridryder911 said:
Oh, c'mon no Lido or better yet no Amiadorone?... C'mon I went all 5 months to Paramedic school! I gotta give something! ..... :D
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Touche', my friend. Touche'.
 
fma08

fma08

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Ridryder911 said:
Oh, c'mon no Lido or better yet no Amiadorone?... C'mon I went all 5 months to Paramedic school! I gotta give something! ..... :D
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Or the 300mg Adeonsine one of my classmates suggested one time <_<

Anywho, do we have some more history on the kid? I'm leaning towards benign as well. So many teens chugging energy drinks and pop these days (I know, cuz I'm one of em). Also, any history of congenital problems?
 
Melclin

Melclin

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Fusion beat from a end-diastolic PVC? Yes, no, maybe, way off?
 
M

MrBrown

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de-ja-vu all over agian; i remember something like this a couple weeks ago

My thoughts

1. It's a PVC
2. PVC's are mostly benign - esp for a 13yo
3. No amiodarone!
 
wvditchdoc

wvditchdoc

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Pvc

I am going to go with it's a PVC, for what it's worth. That being said; I agree with the numerous posts stating that one random PVC or PAC is benign, so treat the patient not the monitor.

Marc
 
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medicnick

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Ridryder911 said:
PAC's usually does not have compensatory pause as well as such as a wide QRS. Abberant PAC in set pattern as well is not the usual. I am surprised that you would request a 12 to determine a PVC or not...

R/r 911
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Actually it is not uncommon to find extended R-R intervals following PACs. There are many examples of it available. This is one of those great EMS myths!

A wide QRS associated with a premature contraction is most likely going to be a PVC but it is also possible for it to be an aberrantly blocked ectopic atrial beat... that would be similar to a RBBB beat.

Cheers,
Nick
 
Ridryder911

Ridryder911

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medicnick said:
Actually it is not uncommon to find extended R-R intervals following PACs. There are many examples of it available. This is one of those great EMS myths!

A wide QRS associated with a premature contraction is most likely going to be a PVC but it is also possible for it to be an aberrantly blocked ectopic atrial beat... that would be similar to a RBBB beat.

Cheers,
Nick
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Although, it can happen the chances in proportion I would not say is common or a myth rather an abnormality, alike A-Fib with third degree.

R/r 911
 
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medicnick

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Ridryder911 said:
Although, it can happen the chances in proportion I would not say is common or a myth rather an abnormality, alike A-Fib with third degree.

R/r 911
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Hi Ridryder,
It actually is not that uncommon. Those of us that work with implanted devices in cardiac patients daily do see this often. We/I may even see this more often than straight PACs.

One thing that is interesting is that the information available on a surface EKG whether a 3 lead or 12 lead is rather limited and depends on specific features to be available.

I would recommend that people keep an open mind and no matter what they may see on an EKG always consider that it may not be what they think it is. With just a simple EKG you can never be certain and once you think that you are 100% right something else will come along and trip you up.

Cheers,
Nick
 
Ridryder911

Ridryder911

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medicnick said:
Hi Ridryder,
It actually is not that uncommon. Those of us that work with implanted devices in cardiac patients daily do see this often. We/I may even see this more often than straight PACs.

One thing that is interesting is that the information available on a surface EKG whether a 3 lead or 12 lead is rather limited and depends on specific features to be available.

I would recommend that people keep an open mind and no matter what they may see on an EKG always consider that it may not be what they think it is. With just a simple EKG you can never be certain and once you think that you are 100% right something else will come along and trip you up.

Cheers,
Nick
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I agree, and point taken as well a good H & P will help eleminate some confusion as many patients do not always have implanted devices.

As usual the old saying, when you hear hoof beats think of zebras...


R/r 911
 
fma08

fma08

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medicnick said:
Hi Ridryder,
It actually is not that uncommon. Those of us that work with implanted devices in cardiac patients daily do see this often. We/I may even see this more often than straight PACs.

One thing that is interesting is that the information available on a surface EKG whether a 3 lead or 12 lead is rather limited and depends on specific features to be available.

I would recommend that people keep an open mind and no matter what they may see on an EKG always consider that it may not be what they think it is. With just a simple EKG you can never be certain and once you think that you are 100% right something else will come along and trip you up.

Cheers,
Nick
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What's that saying again? Give an EKG to 5 different cardiologists and you'll get 5 different interpretations... ^_^
 
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medicnick

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fma08 said:
What's that saying again? Give an EKG to 5 different cardiologists and you'll get 5 different interpretations... ^_^
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That can also be true. If you are curious sometime, google "ekg core lab".

I have worked with the Duke Clinical Research Institute as an EKG core lab. Usually labs like this apply standard criteria to EKGs to have a high interreader reliability. People can still disagree on the diagnosis but usually it is only when they use a different criteria.

That is also true and many people don't realize it. There are a number of different algorithms used by computers and used by cardiologists to interpret EKGs.

One of the old standards is the Minnesota Code. You can read more about it at http://www.epi.umn.edu/ecg/ . Duke has their own algorithm for reading stress tests.

I work with a couple of the old time cardiologists including the coinventor of the Holter monitor... and work for the inventor of the original ICD and rechargable battery. Those pacemakers and defibrillators can last 30 years but they are not so popular now for some reason.

Cheers,
Nick
 
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