Accelerated Idioventricular Rhythm Clinical Presentation

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

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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.

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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]

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