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Health and medicine, rhythm disorders
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ACD 8/18/14“A weird feeling”CARRIE HYDE, PGY 2
UAMS, INTERNAL MEDICINE
Rhythm Strip from OSH
Presenting EKG
CXR
Day 2 EKG
Day 3 EKG
Day 9 EKG
Atrioventricular Block
Atrioventricular (AV) block is defined as a delay or interruption in the transmission of an impulse from the atria to the ventricles due to an anatomical or functional impairment in the conduction system. The conduction disturbance can be transient or permanent, and it can have many causes
Heart block Review
First Degree AV block PR interval greater than 0.20 seconds, Tx: correct electorlytes, caution with
introducing any drug that may slow conduction
Second Degree AV block **Mobitz type I (AKA Mobitz I/Wenchebach): progressive prolongation of PR interval
with dropped beats. Always with a fixed ratio of P waves to QRS waves. Tx: no specific treatment, if symptomatic, can treat with IV atropine or isoproterenol
Mobitz type II (AKA Mobits 2): PR interval remains unchanged prior to the P wave, which suddenly fails to conduct to the ventricles, almost always a disease of the distal conduction system. This may progress to complete heart block Tx: implanted pacemaker
Third Degree (complete) AV block No association between P waves and QRS complexes. Most common etiology is
coronary ischemia. Tx dual chamber pacemaker, emergency tx involves electrical pacing, but AHA recommends giving a trial of atropine (even though it is thought that there will be no effect on third degree heart block)
Summary & Recommendations
Know your AV blocks
Remember there are multiple causes of heart block, like hypothyroidism, that should be investigated