Atrial fib. with PVC's?

Crumbwannabe · Dec 4, 2004

1) my last post wasn't directed at yours, but i'll reply to your post..
2) Abnormal condution pathways are usually responsible for atrial dysrhythmias, not PVC's. That is the stuff of a different thread, like 'what causes svt or wpw, etc.'... so it's kinda irrelevant here
3) By 'Fluff', i meant that discussion of other sources of wide-bizarre complexes in a-fib is inconsequential to the origional question. the answer is 'yes..pvc's occur in a-fib'. Ashmans, abberant pathways, etc. is kinda like a different discussion..
4) You're mistaken with your '3 basic dysrhytmias'...Indeed, AFib/Flutter are both SV dysrhythmias..so actually there are only 2..atrial or ventricular (SV simply means the arrhythmia is occuring above the ventricles (ie in the atria)
5) Cardiac tissue DOES become irritable (can happen in more ways than one). a) have you ever pulled a SWAN and seen pvc's (happens all the time) because the catheter passes through and 'irritates' the Right ventricle b) ischemic insult obviously causes cardiac irritability... thats where MI related VT/VF comes from c)cardiac tissue can become irritable in electrolyte disturbances and cause pvc's. d) by 'irritable' i dont mean itchy, but your attempt at the humorous 'itch-cream' analogy was actually a good one...for instance lidocaine directly 'numbs' and sooths irritated heart muscle and lessens ventricular ectopy...
6)i'll stop short of picking your post completely apart because i have an awful record of getting my posts pulled for flaming...
7)ep book? I've worked with ep-docs for a number of years and am very familiar with arrythmias, their cause, and treatment.
8)I think you should re-read my previous posts because i'm not sure if you understood them..or perhaps you should get a simpler ep-book.
9) i apologize if you thought my last post was an attempt at bashing yours

Ouch... don't take much to set you off, does it?

I won't argue, shucks, I worked with E/P docs and all that for years, too, but they were probably not real good. We're kind of hayseeds sometimes here in the midwest. Thanks for bein' a good Church-goin' type and not tearing me to shreads in public. I'm beholdin' to ya.

If I can find a less highfalutin' book than Foguros, I will, 'cause I know they have an A&P coloring book out there, too, and maybe there's a market for some really simple E/P learnin's. ("Alice and Jerry meet Dr. Jackman at NASPE"?) Don't tell anyone, but you wouldn't believe who I got drunk with one year at NASPE accidentally, but it wasn't Jackman.

Anyhow, I give up, I didn't mean nothin'. No need to have a big donnybrook over a specialty that's still in it's childhood like E/P is. (Unless you want to bring Wenkebach into it,counting the pulse and watching the jugular veins.) Why I remember, back in my day, they used to send people over from Europe to our facility so that a cardiac surgeon could ablate WPW. They'd bring this skinny little doctor and all these big machines with dials and knobs and more buttons than a dog's got fleas on this cart into the room... And believe it or not, sometimes we used to sew these patches kinda looked like a fly swatter right slap onto the heart for ICDs (AICDs back then, 'till Medtronic and all them had to stick their nose in.). I think it was for PVCs, but we weren't sure what they really were, 'cause the heart was still a-beatin' and we didn't have your phone number.

I'll tell ya, those were the days, though, these kids don't know how good they have it now. I mean that. I used to walk 1 1/2 miles from the parking garage in the snow every morning...didn't think anything about it...but we were happy with what we had even if we didn't know a PVC from Adam's cat.

No shame for me to have been outdone by you, 'cause I didn't mean nothin in the first place, and I'm still trying to figure out why lidocaine doesn't supress overdrive pacing and what I'm gonna call them big waves during S/G removal. I mean, you keep a-sayin' the ventricles are really irritable, and here I thought you just take it down to the level of a cell, being troubled by what a feller calls "mechanical stimuli". Then somehow that starts to settin' off the cells around it 'cause of them ions gettin' sucked into the first cell. Like skippin' a rock in the lake when you're a kid, but different. ((But off the subject, since you seem to have a pretty good knowledge of stimuli and response and these sorts of things, maybe you know; if you are ticklish to begin with, why can't you tickle yourself?) (And why did Kamikazie pilots wear helmets?)[ And if you put enough lidocaine in the lake would that make the water less irritable and make smaller waves?])). I think a lot sometimes.

...Thanks for your restraint and your gentle counsel. I gotta go, I'm checkin' for a bad Christmas light on the trailer, I think it's a green one, I ain't plugged 'em in since last year, just left 'em up, that's what we do in the neighborhood. Now I gotta find out which one's burned out, Then after that I gotta run over at Jimbo's and help him carry the plaster Virgin Mary on the Half Shell in so's he can touch it up, and drink a few cold ones. His wife's funny about that every year with the Mary.

Merry Christmas....

pricklypear · Dec 7, 2004

jeeze...talk about irritable

Rookie · Dec 9, 2004

I had a patient on the treadmill with AFIB yesterday who had numerous PVC's and even a 5 beat run of VTACH. PVC's can happen anytime.

Rookie · Dec 9, 2004

I have been in cardiology for 22 years and it never occurred to me that you cant call a PVC a PVC with AFIB but that is technically correct no matter how you slice it. But since most people are familiar with the term PVC, I'll probably keep calling it that even in cases of AFIB.

Crumbwannabe · Dec 16, 2004

I have been in cardiology for 22 years and it never occurred to me that you cant call a PVC a PVC with AFIB but that is technically correct no matter how you slice it. But since most people are familiar with the term PVC, I'll probably keep calling it that even in cases of AFIB.

Hi

If we answer this question, have we accomplished anything? Serious, no sarcasm intended.

All we can do is argue with docs, peers, and worst of all, those people who have to have a special name tag made to list all their credentials [bSN, MSN, CCRN, KGB, ASPCA, DDS, and 37 different colored ribbons for everything from toenail fungus to male pattern balding]... (with an R.N. stuck in there somewhere which is kinda silly, because MSN implies RN, & BSN), and a back brace to hold the whole contraption up. Sarcasm intended.

"A PVC by any other name is just as annoying"...anonymous

Nurse956 · Dec 31, 2005

I know this is an old post but it hit close to home. I recently had a patient who was chronic afib and had surgery and postop they were still in afib with low B/P and CI's. We bolused with amio and started a drip but later in the shift it started looking like PVC's, I mean textbook PVC's, then 5-7 beat runs of VTACH. I called the physician who had me march it out. It was pretty regular but would have an irregular beat here or there. The doc said it was probably abberant afib which was new to me at the time. About an hour later the pt went into sustained VTACH then into V-fib and despite our best efforts could not be revived.

Just a note so that people stay serious about these beats.

rcpals · Jan 10, 2006

Look, its like this. Ventricular ectopy can happen in any rhythm. Premature beats generally happen on regular rhythms. We dont call a ventricular beat in afib a "PVC" It cant be premature in afib because we dont know when to expect the next beat. You are accurate to say the pt is in Afib with occasional ventricular complexes.

Your inaccurate if you say pvcs. You know how lawyers are. They will look for small discrepencies to pick apart and show the jury that you dont really know what your talking about. Please be accurate in how you describe these things. What you document can save you or hang you.

Its all good... Jeff RCP

Dinith88 · Jan 10, 2006

Look, its like this. Ventricular ectopy can happen in any rhythm. Premature beats generally happen on regular rhythms. We dont call a ventricular beat in afib a "PVC" It cant be premature in afib because we dont know when to expect the next beat. You are accurate to say the pt is in Afib with occasional ventricular complexes.
Your inaccurate if you say pvcs. You know how lawyers are. They will look for small discrepencies to pick apart and show the jury that you dont really know what your talking about. Please be accurate in how you describe these things. What you document can save you or hang you.
Its all good... Jeff RCP

Good post...but you failed to read the other posts that said the same thing...without mentioning lawyers...

rcpals · Jan 10, 2006

The lawyers are the best part and I did read the other posts. In medicine today we have to be as accurate as possible. Picture this, you document PVCs with afib and something went wrong with your pt.

The lawyer gets you up on the stand and asks about your documentation. Specifically about the PVC and afib statement. He would try and prove that you were inaccurate about your description and force you to say " ok you cant have PVCs in Afib and I did not accurately chart it." All he has to do is put some doubt about your clinical skills into the LAYPERSON jurys mind and your in trouble. This is not to say that the inaccurate description made a difference clinically but the lay people jury dont know that. They just know that if your wrong on this you might be wrong at other things also. Now they doubt you...

I just want to emphasize the importance of accuracy. Word mean things and people will judge you by the words you speak or write. Is that reasonable?

Have a great day all...

Jeff:specs: