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Adult Health II - Cardiac Dysrhythmias Part 3 (1).
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Adult Health II - Cardiac Dysrhythmias Part 3 (1).
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Adult Health II - Cardiac Dysrhythmias Part 3First degree AV block
Second degree AV block, Type I and Type 2
Third degree AV block (complete heart block)
Assess PR interval - ANS-Conduction Abnormalities = AV blocks
medications (i.e., digoxin, CCB, BB), Lyme disease (very common), myocardial ischemia,
valvular disorders, cardiomyopathy, endocarditis, myocarditis - ANS-AV block etiology
signs and symptoms vary with the resulting ventricular rate and the severity of any underlying
disease processes
Can result in decreased perfusion to vital organs (heart, lungs, brain, kidneys, skin) - ANS-AV
block manifestations
Occurs when the atrial impulses are conducted through the AV node into the ventricles at a rate
that is slower than normal - ANS-First Degree AV Block
Ventricular and atrial rate: depends upon the underlying rhythm
Ventricular and atrial rhythm: depends upon the underlying rhythm
QRS shape and duration: usually normal, but may be abnormal
P wave: in front of the QRS complex; sinus rhythm with a regular shape
PR interval: >0.20 and the PR measurement is constant
P:QRS ratio: 1:1 - ANS-First Degree AV Block characteristics
Rarely causes any hemodynamic effect or treatment
Treat the patient, not the underlying cardiac rhythm! - ANS-First Degree AV Block: Medical
Management
Occurs when there is a repeating pattern in which all but one of a series of atrial impulses are
conducted through the AV node into the ventricles
Each atrial impulse takes a longer time to conduct than the one before, until one impulse is fully
blocked (no QRS complex after a P wave) - ANS-Second Degree AV Block, Type I
(Wenckebach)
Ventricular and atrial rate: depends upon the underlying rhythm, but the ventricular rate is lower
than the atrial rate
, Ventricular and atrial rhythm: the P-P interval is regular if there is underlying NSR; the R-R
interval changes and gets progressively longer, then shortens again after a QRS complex no
longer follows a P wave
QRS shape and duration: usually normal, but may be abnormal
P wave: in front of the QRS complex; shape depends on the underlying rhythm
PR interval: becomes progressively longer with each succeeding QRS complex until there is a P
wave that is not followed by a QRS complex (then it starts all over again)
P:QRS ratio: 3:2, 4:3, 5:4, and so forth - ANS-Second Degree AV Block, Type I (Wenckebach)
characteristics
Medical management is based on the hemodynamic effect of the rhythm
1. Asymptomatic patients do not require any treatment
2. Symptomatic patients: atropine or temporary transcutaneous or transvenous pacing + a
Cardiology consult - ANS-Second Degree AV Block, Type I:Medical Management
Occurs when only some of the atrial impulses are conducted through the AV node into the
ventricles - ANS-Second Degree AV Block, Type II (Mobitz)
Ventricular and atrial rate: depends upon the underlying rhythm, but the ventricular rate is lower
than the atrial rate
Ventricular and atrial rhythm: the P-P interval is regular if there is underlying NSR; the R-R
interval is usually regular, but may be irregular, depending upon the P:QRS ratio
QRS shape and duration: usually normal, but may be abnormal
P wave: in front of the QRS complex; shape depends on the underlying rhythm
PR interval: the PR interval is constant for those P waves just before QRS complexes
P:QRS ratio: 2:1, 3:1, 4:1, 5:1, and so forth - ANS-Second Degree AV Block, Type II (Mobitz)
characteristics
Often deteriorates into complete heart block
Atropine is NOT effective
May require temporary transcutaneous or transvenous pacing until a permanent pacemaker can
be placed (if you cannot stop medications) - ANS-Second Degree AV Block, Type II (Mobitz)
medical management
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