Accelerated junctional rhythm

Vomiting is common in patients with digitalis overdose. Hyperkalemia may be caused by acute digitalis overdose or severe poisoning, whereas hypokalemia may be present in patients as a result of long-term diuretic treatment. (Digitalis does not cause hypokalemia.) A variety of cardiac rhythm disturbances may occur, including sinus bradycardia, AV block, atrial tachycardia with block, accelerated junctional rhythm, premature ventricular beats, bidirectional ventricular tachycardia, and other ventricular arrhythmias. 

Unifocal or multiform ventricular premature contractions, ventricular tachycardia, atrioventricular dissociation, accelerated junctional rhythm, and atrial tachycardia with block... 

IV. Diagnosis is based on a history of recent overdose or characteristic arrhythmias (eg, bidirectional tachycardia and accelerated junctional rhythm) in a patient receiving chronic therapy. Hyperkalemia suggests acute ingestion but may also be seen with very severe chronic poisoning. Senim potassium levels higher than 5.5 mEq/L are associated with severe poisoning. 

Similarly, some systems identify an event sensed on the ventricular channel of the pacemaker which is not preceded by an atrial event, either paced or sensed, as a premature ventricular contraction (PVC). PVC s have a very definite implication for the clinician. The pacemaker s definition is far more specific as the pacemaker cannot analyze the morphology of the complex. Hence, nonphysiologic make-break electrical potentials associated with an internal insulation failure or conductor fracture will also be identified as PVCs as will accelerated junctional rhythms or episodes of atrial undersensing but with intact AV nodal conduction. Some systems may also identify runs of ventricu-... 

Need to differentiate accelerated junctional rhythm from accelerated idioventricular rhythm (a possibly life-threatening arrhythmia)... 

Accelerated junctional rhythm and an accelerated Idioventricular rhythm appear similar but have different causes. To distinguish between them, closely examine the duration of the QRS complex, and then look for P waves. 

May be no symptoms because accelerated junctional rhythm has the same rate as sinus rhythm. 

Treatment for accelerated junctional rhythm involves identifying and correcting the underlying cause. 

Atrial and ventricular rhythms regular atrial rate 40 to 60 beats/minute ventricular rate usually 40 to 60 beat minute (60 to 100 beat minute is accelerated junctional rhythm). 

B. With chronic intoxication, visual disturbances, weakness, sinus bradycardia, atrial fibrillation with slowed ventricular response rate or junctional escape rhythm, and ventricular arrhythmias (ventricular bigeminy or trigeminy, ventricular tachycardia, bidirectional tachycardia, and ventricular fibrillation) are common. Accelerated junctional tachycardia and paroxysmal atrial tachycardia with block are frequently seen. Hypokalemia and hypomagnesemia from chronic diuretic use may be evident and appear to worsen the tachyarrhythmias. 

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