PVC and PAC in ECG rhythm

Specialties CCU

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Hi I am a new icu nurse.... Working on to get knowledge in ECG strips ... How significant is these two rhythms? When you see monitor alarming for multiple PAC and PVC ... What should I do? I have never seen any of my senior nurses informing to doctors... I don't know what happens? And what should I do? I just don't want to blindly follow without knowing reasons... And I am a kind of person who never speaks loud or bring my thoughts out until and unless I have felt ease with them... So passive... Could anyone help me?

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Specializes in ED, ICU, Education.

I would suggest taking a 12 lead EKG class. Is it not mandatory where you work? Recognizing all types of cardiac rhythms is definitely a qualification for any ICU nurse (where I work anyways).

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PVCs and PACs are not rhythms in and of themselves. They're a form of ectopy--irregular heartbeats that occur in what's usually an otherwise normal rhythm. How serious they are relates to how frequently they occur and if the patient is experiencing symptoms. Remember--with EKGs, it's not about the monitor. Look at your patient and go from there for treatment. Often times, these things won't be treated unless the patient is symptomatic.

Echoing what resumecpr said...you definitely need to pick up a basic dysrhythmias course at very least if you're still fuzzy on cardiac stuff.

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Thanks a lot for your reply and I am planning to take ECG classes next month

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Specializes in ICU.

It's not so much if they are there, it's if they are increasing in number and frequency. Never hurts to take a peek at the last set of labs for a K+ or Mg++ that was low and never supplemented. Are they being diuresed? Lytes might be low now due to that, or if a lot of fluid has been removed (like KD or CVVH), they might be getting dry. That's why patients have heart attacks in outpatient dialysis. Happens quite often actually. :nailbiting: Good question, not an easy answer.

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Thanks ... You are right .. That particular patient was on LASIx 80 mg twice a day for pat two days .... I didnot have look on magnesium and potassium levels... That's good to know ... Next time I can have a eye on it... May heart was irritable due to electrolyte imbalance...

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One thing I would recommend is changing that last part of your post. Ask questions, ask questions, ask questions. Especially as a new nurse. I've been in the ICU for 18 months now, and I still ask my charge nurse or the more experienced nurses questions on a daily or weekly basis. You're not expected to magically know everything right away, so find someone you look up to and ask questions. Posting on allnurses is good too. ;)

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Yes phi gam.. I am trying to change my attitude to open my mouth and speak... It is helping lot if I ask...

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Increasing PACs can be a precursor to a-fib or a-flutter, so an increase in PACs in a pt that hasn't been having them would warrant a mention to a doc. Many people live with frequent PVCs. Are they increasing in number, is BP affected, is pt having any symptoms. I usually look at the last labs, meds, etc. I bring up the increase in PVCs to the doc and they usually order a K+ and Mg++ to be sent and replace as necessary. Don't be afraid to ask your fellow nurses if you have questions. The ICU is no play to be shy.

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Specializes in Critical Care.

Depends in what context they are occurring in. Most as themselves they are benign. Now if they start getting fancy and coupling and throwing some runs and stuff then you may wanna check some labs.

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