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Conduction abnormalities
part II
Sruthi Meenaxshi
AV 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
Types
• First degree AV block – Delayed conduction from the atrium to the
ventricle (defined as a prolonged PR interval of >200 milliseconds) without
interruption in atrial to ventricular conduction.
• ●Second-degree AV block – Intermittent atrial conduction to the ventricle,
often in a regular pattern (eg, 2:1, 3:2, or other pattern), which are further
classified into Mobitz type I (Wenckebach) and Mobitz type II second
degree AV block.
• ●Third-degree (complete AV) block – No atrial impulses conduct to the
ventricle.
• ●High-grade AV block – Intermittent atrial conduction to the ventricle with
two or more consecutive blocked P waves but without complete AV block.
Etiology of AV Block
Class I indication for Pacing
• Complete (third degree) AV block with or without symptoms
• Advanced second degree AV block (block of two or more
consecutive P waves)
• Symptomatic second degree AV block, Mobitz type II
• Symptomatic second degree AV block, Mobitz type I (Wenckebach)
• Second degree AV block, Mobitz type II with a widened QRS or
chronic bifascicular block, with or without symptoms
• Exercise-induced second or third degree AV block (in the absence of
myocardial ischemia)
A 12 year old boy admitted with painful joints
migratory and fever with Ecg showing the
Following adnormality ?What is your probable
diagnosis?
First degree Av Block- Prolonged PR interval
>200
AV Block: 2nd degree, Mobitz I (Wenckebach
Phenomenon)
• Progressive prolongation of the PR interval culminating in a non-
conducted P wave
• The PR interval is longest immediately before the dropped beat
• The PR interval is shortest immediately after the dropped beat
Second degree AV block (Wenkebach
Phenomenon) with 5:4 conduction block
Note P wave
Progressive prolongation of PR Interval
Comment on conduction ratio P:QRS
Wenkebach phenomenon
A 55 year old male presented to ED with chest pain and palpitation.
Cardiac biomarkers were elevated .
Ecg showed the following abnormality .what is probable diagnosis and
localize the territory of MI
• A case of inferior wall MI , with RV infarction
• Note the progressive prolongation of PR interval with dropped beat
Conduction ratio is 2 :1 (showing wenkebach phenomenon)
Since ST Elevation lead III>lead II ( RCA territory infarct )
AV Block: 2nd degree AV block, Mobitz II (Hay
Block)
• Intermittent non-conducted P waves without progressive
prolongation of the PR interval
• Mobitz typeII predominantly infrahisian associated with wide QRS
and bifascicular and trifascicular blocks
• Atropine hence contraindicated as it may progress to 3 rd degree
AV Block
Fixed block mobitz type 2 (4:1)
A 54year old with progressive muscle dystrophy
presented with this Ecg abnormality.identify
• A case of limb girdle muscular dystrophy with mobitz type 2 block
• Class I indication for PPI
Complete heart block (Third degree)
Complete heart block
AV dissociation
Complete heart block with inferior wall MI
CHB with isorhythmic AVdissociation
Thankyou

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Conduction abnormalities part 2

  • 2.
  • 3. AV 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
  • 4. Types • First degree AV block – Delayed conduction from the atrium to the ventricle (defined as a prolonged PR interval of >200 milliseconds) without interruption in atrial to ventricular conduction. • ●Second-degree AV block – Intermittent atrial conduction to the ventricle, often in a regular pattern (eg, 2:1, 3:2, or other pattern), which are further classified into Mobitz type I (Wenckebach) and Mobitz type II second degree AV block. • ●Third-degree (complete AV) block – No atrial impulses conduct to the ventricle. • ●High-grade AV block – Intermittent atrial conduction to the ventricle with two or more consecutive blocked P waves but without complete AV block.
  • 6. Class I indication for Pacing • Complete (third degree) AV block with or without symptoms • Advanced second degree AV block (block of two or more consecutive P waves) • Symptomatic second degree AV block, Mobitz type II • Symptomatic second degree AV block, Mobitz type I (Wenckebach) • Second degree AV block, Mobitz type II with a widened QRS or chronic bifascicular block, with or without symptoms • Exercise-induced second or third degree AV block (in the absence of myocardial ischemia)
  • 7. A 12 year old boy admitted with painful joints migratory and fever with Ecg showing the Following adnormality ?What is your probable diagnosis?
  • 8. First degree Av Block- Prolonged PR interval >200
  • 9. AV Block: 2nd degree, Mobitz I (Wenckebach Phenomenon) • Progressive prolongation of the PR interval culminating in a non- conducted P wave • The PR interval is longest immediately before the dropped beat • The PR interval is shortest immediately after the dropped beat
  • 10. Second degree AV block (Wenkebach Phenomenon) with 5:4 conduction block
  • 11. Note P wave Progressive prolongation of PR Interval Comment on conduction ratio P:QRS Wenkebach phenomenon
  • 12. A 55 year old male presented to ED with chest pain and palpitation. Cardiac biomarkers were elevated . Ecg showed the following abnormality .what is probable diagnosis and localize the territory of MI
  • 13. • A case of inferior wall MI , with RV infarction • Note the progressive prolongation of PR interval with dropped beat Conduction ratio is 2 :1 (showing wenkebach phenomenon) Since ST Elevation lead III>lead II ( RCA territory infarct )
  • 14. AV Block: 2nd degree AV block, Mobitz II (Hay Block) • Intermittent non-conducted P waves without progressive prolongation of the PR interval • Mobitz typeII predominantly infrahisian associated with wide QRS and bifascicular and trifascicular blocks • Atropine hence contraindicated as it may progress to 3 rd degree AV Block
  • 15. Fixed block mobitz type 2 (4:1)
  • 16.
  • 17. A 54year old with progressive muscle dystrophy presented with this Ecg abnormality.identify
  • 18. • A case of limb girdle muscular dystrophy with mobitz type 2 block • Class I indication for PPI
  • 19. Complete heart block (Third degree)
  • 20. Complete heart block AV dissociation
  • 21. Complete heart block with inferior wall MI
  • 22.
  • 23. CHB with isorhythmic AVdissociation
  • 24.