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Final Exam Dysrhythmia
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First Degree Atrioventricular Heart Block - prolonged PR interval-measures the time required for an impulse to travel from the SA to the AV node. PRI longer than 0.20 Second degree AV block Type I - progressive prolongation of PRI, gradual shortening of R to R intervals P wave not followed...

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  • August 1, 2023
  • 37
  • 2023/2024
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Final Exam Dysrhythmia


First Degree Atrioventricular Heart Block - prolonged PR interval-measures the time required for an
impulse to travel from the SA to the AV node. PRI longer than 0.20



Second degree AV block Type I - progressive prolongation of PRI, gradual shortening of R to R intervals



P wave not followed by a QRS wave



a pause with an R to R interval less than the sum of two P to P intervals



first conducted atrial impulse after the pause shows a shorter or normal PRI



Second Degree AV Block Type 2 - Rhythm: ventricular irregular; atrial regular

Rate: atrial rate > ventricular rate

P waves: P waves may not be followed by QRS

PRI: WNL or prolonged ; PRI before and after a blocked P waves are constant.

QRS duration: WNL; greater than 0.11 sec block occurs below the bundle.



characteristics of first degree AV block - rhythm: regular

Rate: usually WNL

P waves: one positive before each QRS complex

PRI: prolonged

QRS: normal



causes of first degree AV block - - normal in hx of cardiac disease especially athletes

- Acute MI

- acute mydocarditis or endocarditis

,- cardiomyopathy

- degenerative fibrosis and sclarosis

- drugs

- hyperkalemia

- increased vagal tone

- ischemia or injury to the AV node or AV bundle

- rheumatic heart disease

- valvular heart disease



what causes second degree AV block type I - RCA, athletes, aortic valve disease, atrial septal defects,
meds, mitral valve prolapse, rheumatic heart disease.



what do i do about second degree AV block type I - atropine for bradycardia.



second degree AV block type II causes - MI is related to conduction effects, acute myocarditis, aortic
valve disease, cardiomyopathy, fibrosis of the conduction system, rheumatic heart disease



second degree AV block type II s/s - depends on the ventricular rate: if normal it is asymptomatic. could
progress to third degree, pacemakers, ECG, pulse ox, obtain VS, administed oxygen, est IV access



temporary or permanent pacing



third degree heart block - Rhythm: ventricular regular; atrial regular, no relationship is present



Rate: the atrial rate is greater than the ventricular and the ventricular rate is determined by the escape



P waves: normal in size and shape; not followed by a QRS complex



PRI: no PRI bc they are not related

,QRS: narrow or wide depending on the location of the pacemaker



hypokalemia T waves - depressed T waves



hyperkalemia T waves - elevated T waves



causes of third degree heart block - acute MI

acute myocarditis

congenital heart disease

drug effect

fibrosis of the conduction system

increased parasympathetic tone



capture - The successful conduction of an artificial pacemaker's impulse through the myocardium,
resulting in depolarization



demand pacemaker - Pacemaker that discharges only when the patient's heart rate drops below the
preset rate for the pacemaker; also known as a synchronous or noncompetitive pacemaker.



dual chamber pacemaker - Pacemaker that stimulates the atrium and ventricle; dual-chamber pacing is
also called physiologic pacing. They must get counseling because it hurts



Fixed rate pacemaker - Pacemaker that continuously discharges at a preset rate regardless of the
patient's intrinsic activity; also known as an asynchronous pacemaker



Sensitivity - the extent to which an artificial pacemaker recognizes intrinsic cardiac electrical activity.



Temporary Pacemaker's - transcutaneous: pads that go on the body

transvenous: introduced into a central vein like the subclavian, femoral, brachial, internal or external
jugular vein

, complications of pacemaker: - bleeding, infection, MI, PE, dysrhythmias, wires can come loose, battery
changes, no MRI, cannot do electromagnetic



for transcutaneous: hold pressure for 20 minutes and tell the patient not to bend their legs.



12 lead ECG - Limb leads: I, II, II, AVR, AVL, AVF



Chest leads: V₁ , V₂ , V₃ , V₄ , V₅ , V₆



Where are the 12 lead ECG's placed - Lead I: receives information from R and L arms; dipolar views top
of the heart



Lead II: receives information from R arm and L foot



lead III: receives information from Left leg and arm



avR: on the Right arm



avF: on the right foot



avL: on the Left arm



Normal Sinus Rhythm - rhythm: R-R and P-P intervals are regular



rate: 60-100 bpm



P waves: positive (upright) in lead II; one precedes each QRS complex, P waves look alike

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