Abberancy and RVR?

Wow. I work on a post surg. tele unit, and this isn't ringing a bell. Thanks a lot for sending me back to my books to look this up.

Generally on my unit we see certain things, mainly A-fib, PACs, PVCs, runs of V-tach, etc. I need to read up more!

I think it is easy to lose familiarity with things you don't see that often. For instance, a rhythm that was identified by another nurse as accellerated juctional, when I took a look at it (and asked 2 other nurses with more experience to take a look at it) I judged it as SR with an enormous 1st degree AVB. (P waves buried in Twaves) Everything is a learning curve.

From the minimal experience I've had so far, I've caught on that a pt in A.Fib with a HR, say in the 150's, is having a rapid ventricular response. Is that right? Even so, I still don't quite understand what's going on with a pt in A.Fib with RVR (and it's the RVR part I don't get). Anyone care to explain, or lead me in the right direction? :)

And with abberancy... When this is going on, the QRS looks wider? If I'm even right, that's ALL I know about abberancy. So I could use some clarification there too.

I don't remember ever hearing these terms in nursing school, and I'm not having much luck finding this information online (although I'm sure it's out there somewhere). So any help from you guys would be VERY appreciated!

Since I can't look at the strip, I'll try to help. Afib is a disfunction of the atrium- therefore it is a ventricular rhythm in that the ventricle is carrying the beat. The ventricles may fire off at a faster rate, because it's having a hard time carrying the beat without the atrial kick it needs to function properly- the ventricle is "confused." The atrium is quivering, instead of giving off it's usual squeeze, and the electrical impulse is not focused- it may be coming from all over the atrial tissue. Some signals may make it through the AV node to the ventricle and some don't, so the rhythm will usually be irregular as well. A RVR denotes an unstable afib, and the patient may need cardioversion (along with beta/calcium channel blockers) before his pressure drops- a fast-beating ventricle is not able to push out enough blood to keep the pressure up. Remember your anatomy, and the electrical pathway (SA node, AV node, etc). If you look at a diagram of the electrical pathway, it will help.

The wide QRS could be a bundle branch block. We see this with afib on the CCU pretty often, and it could also contribute to the rapid ventricular response. A BBB is a conduction problem further down the electrical pathway.

I hope this made sense, and helped a little. :)

Abberant beats do not take the normal electrical pathway. Think of it as the electrical activity taking the long way around. The cells still depolarize but the conduction is slower because it is not being passed down through the normal and fast specialized electrical cells of the SA-AV-Bundles-perkinges-etc.

The difficulty lies in distinguishing afib with RVR and abberancy from Vtach. It will appear as a wide complex tachycardia. A rate above 150 may appear regular. There are ways to determine whether VT or abberancy with an ECG but I don't know them.... it has to do with difflection in certain leads. In most cases, I would say it is just treated as VT since this is usually considered an emergent situation especially if the pt is symptomatic.

From the minimal experience I've had so far, I've caught on that a pt in A.Fib with a HR, say in the 150's, is having a rapid ventricular response. Is that right? Even so, I still don't quite understand what's going on with a pt in A.Fib with RVR (and it's the RVR part I don't get). Anyone care to explain or lead me in the right direction? :)

And with abberancy... When this is going on, the QRS looks wider? If I'm even right, that's ALL I know about abberancy. So I could use some clarification there too.

I don't remember ever hearing these terms in nursing school, and I'm not having much luck finding this information online (although I'm sure it's out there somewhere). So any help from you guys would be VERY appreciated!

RVR is just another way of saying 'fast' or 'uncontrolled' a-fib. It just means the AV-node/ventricles are overwhelmed by all the 'static' being created by the fibrillating atria...and respond by going hog-wild and depolarizing/contracting a bit too often.

Aberrant conduction just means that when the heart contracts, the electrical 'impulse' that travels through the conduction-fibers decides (for whatever reason) to take a different route. This causes the QRS (on tele) to look unlike the base-line QRS. It's usually wide and has a bundle-branch-block appearance. It's benign and wont hurt the patient...but because it can appear wide (like pvc's) it can freak-out the nurses who think they're seeing v-tach.

I found those site, in hope they will help you:

http://library.med.utah.edu/kw/ecg/ecg_outline/Lesson5/ventricular.html

http://www.mededsys-nurse.com/courses_online/203/203.html#c_five