Accelerated Idioventricular Rhythm Clinical Presentation

Updated: Dec 21, 2016
  • Author: Nayereh G Pezeshkian, MD; Chief Editor: Jeffrey N Rottman, MD  more...
  • Print
Presentation

History

History is helpful for identifying the underlying etiology for AIVR. The presence of the following conditions supports a potential diagnosis of AIVR:

  • Most patients with AIVR have chest pain or shortness of breath, symptoms related to myocardial ischemia. They often have recent history of myocardial reperfusion with drugs or coronary artery interventions. [16]
  • Some patients with AIVR have chest discomfort, shortness of breath, peripheral edema, cyanosis, clubbing, symptoms related to cardiomyopathy, myocarditis, and congenital heart diseases.
  • Occasionally, patients with AIVR have history of using digoxin, some anesthetic agents, or illicit drugs such as cocaine.
  • Rarely, AIVR can occur in people without apparent heart disease and no identifiable triggers.
Next:

Physical

There are no specific physical findings for AIVR. The following physical signs may be present:

  • Slow (< 55 bpm) or fast (>100 bpm) pulse rate.
  • Variable heart sound intensity and cannon A waves related to atrioventricular dissociation.
  • Some irregularity of heart rate/pulse rate due to competing sinus rhythm and AIVR.
  • Rarely, hypotension related to either AV asynchrony or relatively rapid ventricular heart rate during AIVR.
Previous
Next:

Causes

The AIVR can occur in people with and without apparent heart diseases. [17] The most common cause of AIVR is myocardial ischemia-reperfusion. Other causes include the following:

  • Buerger disease [18]
  • Congenital heart disease [19]
  • Dilated cardiomyopathy [4]
  • Myocarditis [10]
  • Drugs: Digoxin toxicity, [3] cocaine toxicity, [20] and various anesthesia agents [21, 22]
  • Electrolyte abnormality
  • Postresuscitation [15]

Beach et al reported on the case of a boy aged 4 years who appeared to have developed AIVR from the administration of inhaled albuterol to treat his status asthmaticus. [23]

Previous