Premature junctional contraction
Background
Premature junctional contractions (PJCs) are typically seen in patients with underlying heart failure, digoxin toxity, or myocardial ischemia. They occur due to an ectopic pacemaker within the AV node or AV bundle.[1]
Clinical Features
- Patients may be asymptomatic or experience the following:
- Palpitations
- Shortness of breath
- Anxiety
- Symptoms of underlying disease process
Differential Diagnosis
Palpitations
- Arrhythmias:
- Non-arrhythmic cardiac causes:
- Psychiatric causes:
- Panic attack
- Anxiety
- Somatic Symptom Disorder
- Drugs and Medications:
- Alcohol
- Caffeine
- Drugs of abuse (e.g. cocaine)
- Medications (e.g. digoxin, theophylline)
- Tobacco
- Misc
Evaluation
- Obtain EKG and look for:
- Ectopic P waves that have different morphology than the SA node-initiated P waves
- P waves may occur before or after QRS
- QRS should have similar morphology to SA node-initiated QRS complexes
- PJCs may be isolated, occur in trigeminy or bigeminy, or be multifocal.[2]
- Rule out underlying disease processes such as digoxin toxicity, heart failure, or myocardial ischemia.
Management
- No specific treatment indicated, though treatment of the underlying disorder may be indicated.
Disposition
- Discharge home without specific follow-up, unless indicated for the underlying disorder.
External Links
References
- Brady W, Laughrey T, Ghaemmaghami C. Cardiac rhythm disturbances. In Tintinalli's Emergency Medicine: A Comprehensive Guide. Tintinalli J, et al. ed. 8th ed. McGraw Hill. New York, NY, 2016.
- Brady W, Laughrey T, Ghaemmaghami C. Cardiac rhythm disturbances. In Tintinalli's Emergency Medicine: A Comprehensive Guide. Tintinalli J, et al. ed. 8th ed. McGraw Hill. New York, NY, 2016.
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