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ECG (Heart Blocks) PowerPoint Presentation

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Published on : Dec 06, 2013
Views : 4119 | Downloads : 24

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ECG (Heart Blocks) Presentation Transcript

Slide 1 -

AV Heart Blocks Pauline Seydak, Cardiac Physiology Trainer N.I.

Slide 2 -

AV Nodal Blocks (heart blocks) Disturbances of the conduction through the heart, occurring at the AV Node AV Node – damaged/diseased – delay or total block of impulses at the AV Node This conduction defect can be seen on the ECG

Slide 3 -

1- All the time (but taking a little longer than usual). 2- Some of the time. 3- None of the time. All, some, or none of the time. And see, those are the three kinds, or degrees of heart block: first, second, and third degree. All, some, or none. Here’s the key idea - the signal is either getting through:

Slide 4 -

Causes Increased vagal tone (parasympathetic nervous system) IHD (MI) Endocarditis Degeneration (age) Sclerosis (Aortic) Cardiac surgery trauma

Slide 5 -

AV Node AV nodal conduction time is represented on the ECG as the PR segment. But - we always measure the PR interval.

Slide 6 -

First Degree Heart Block (1º) SA Node – normal Normal P wave AV Node conducts more slowly than normal Prolonged PR Interval Rest of conduction is normal Normal QRS

Slide 7 -

First Degree Heart Block (1º) PR Interval > 0.2 seconds (5 small sq) Note – the PR Interval is constant

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Significance Clinical significance None Treatment None Note – this can progress to 2º or 3º heart block

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Second Degree Heart Block (2º) Mobitz Type I (Wenkebach) Mobitz Type II 2 : 1

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Second Degree Heart Block (2º)Mobitz Type I(Wenkebach) Conduction through the AV Node – progressively delayed until a drop beat is seen Karl Wenkebach

Slide 12 -

Second Degree Heart Block (2º)Mobitz Type I(Wenkebach) PR Interval prolongs with each beat until a dropped beat is seen The PR Interval is NOT constant After each dropped beat, the PR interval is normal and the cycle starts again

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Second Degree Heart Block (2º)Mobitz Type I(Wenkebach) PR PR PR DROPPED BEAT

Slide 14 -

2nd Degree AV block Mobitz 1

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Significance Clinical Significance Slight symptoms eg. Lethargy,Confusion Treatment Pacemaker if during day &/or symptoms No treatment if at night Note – this can progress to 3º Heart Block

Slide 16 -

Second Degree Heart Block (2º)Mobitz Type II Conduction through the AV node is constant. PR interval is normal and constant Occasionally a dropped beat is seen

Slide 17 -

Second Degree Heart Block (2º)Mobitz Type II PR PR DROPPED BEAT PR

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Significance Clinical significance – this is more significant disease Treatment – pacemaker Note – this can progress to 3º Heart Block

Slide 20 -

Second Degree Heart Block (2º) 2 : 1 Unable to strictly classify as Mobitz Type I or II Particular type of second degree Heart Block Ratio 2 P waves : 1 QRS

Slide 21 -

Second Degree Heart Block (2º) 2 : 1

Slide 22 -

Significance Clinical significance – unable to classify as Mobitz type I or II Will be associated with symptoms, dizziness, lethargy etc. Treatment – pacemaker Note – this can deteriorate to 3º Heart Block

Slide 23 -

Third Degree Heart Block (3º)(Complete) Complete failure of the AV Node No impulses from Sinus Node will pass through to the ventricles Some part if the conducting system will take over as pacemaker of the heart (even a myocardial cell 10-15 bpm)

Slide 24 -

Third Degree Heart Block (3º)(Complete) P wave rate – normal Ventricular rate – slow Ventricular complex may be broad Idioventricular rhythm Complete dissociation between P waves & QRS

Slide 25 -

Third Degree Heart Block (3º)(Complete) P P P P P QRS QRS

Slide 26 -

3rd degree AV block

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Significance clinical significance Symptoms LOC, Confusion, Dizziness, Low BP Can lead to standstill, VT or VF (stokes Adams) Treatment - pacemaker

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Summary 1º - prolongation of PR Interval ALL 2º - Mobitz I – Increasing PR Interval until dropped beat is seen SOME Mobitz II – Constant PR Interval with more P waves to QRS 2 : 1 – Constant PR Interval with more P waves to QRS 3º - Complete dissociation between P waves & QRS NONE

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