Admitted directly from EMS to the cath lab

Written by Judy Haluka

You are working in an ICU unit. Your patient is a 56-year-old male who you are admitting from the cardiac catheterization laboratory. He was admitted directly from EMS to the cath lab with an acute anterior wall myocardial infarction. The Left anterior descending artery just before the first diagonal was opened and stented with a 3.5 x 20mm stent. He is pain-free and being admitted to the ICU secondary to his infarction. His vitals are P: 60 BP 154/92 R: 18 saturating at 98% on room air. He has no medical history prior to today. He has received Plavix, Heparin, Versed, and Fentanyl in the lab. He is on a nitroglycerin drip at a rate of 20 mcg/min. The nurse who gives you report says that he has been in sinus rhythm to sinus tachycardia at a rate of 80–110 for the duration of the procedure. You move him into the bed and place him on the cardiac monitor. The patient’s rhythm is below:

What is this rhythm and why?

This is an accelerated idioventricular rhythm (AIVR). It is regular with a heart rate greater than 40 and less than 100. There are no P waves (sinus node is not causing the rhythm) The QRS complex is wide. This is the most common “reperfusion” rhythm in adults.¹ The left anterior descending vessel was occluding proximally causing a large portion of the left ventricle to be ischemic. When flow is returned to the vessel, oxygen-rich blood is sent down the vessel to feed oxygen starved tissue. Many times AIVR is the result.

What should I do?

Chances are, this will be a self-limiting arrhythmia. If the patient remains asymptomatic and hemodynamically stable, no treatment is necessary.

Reference

Gildea, T. H., & Levis, J. T. (2018). ECG diagnosis: Accelerated idioventricular rhythm. The Permanente Journal, 22, 17–173. https://www.thepermanentejournal.org/doi/10.7812/TPP/17-173