Internal Medicine

0521779407-22 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:23

1526 Ventricular Premature Complexes

VENTRICULAR PREMATURE COMPLEXES

EDMUND C. KEUNG, MD

history & physical

History

■Common with structural heart diseases: coronary artery disease,

hypertensive heart disease, rheumatic heart disease, myocarditis,

and cardiomyopathy.

■Also caused by electrolyte imbalance and digoxin toxicity.

■In normals, often associated with stress, tobacco, excessive caffeine

or alcohol intake.

■Decreased intensity of heart sounds and peripheral pulse with the

VPC. Abnormal splitting of the second heart sound.

■Second heart sound is altered, depending on the VPC focus (see BBB

above).

Signs & Symptoms

■Often asymptomatic. Anxiety. Palpitation, irregular pulse. Fatigue

and exacerbation of heart failure.

tests

■Basic Tests

➣12-lead ECG:

➣Premature and wide (>120 ms) QRS complex without preceding

P wave, usually followed by a compensatory pause (R-R interval

encompassing the VPC is twice the regular RR-interval).

■Specific Diagnostic Test

➣none

differential diagnosis

■Atrial premature complex with aberrant conduction, junctional pre-

mature complex, pre-excited QRS complex.

management

General Measures

■No antiarrhythmic treatment because of increased mortality from

such treatment.

■Avoid caffeine, alcohol, tobacco, chocolate, caffeine-containing tea.

specific therapy

■none