ECG: Conduction Block

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ECG: Conduction Block

  1. 1. ECG OF THE WEEK PROF.VIJAYARAGHAVAN’S UNIT M 7 BHARGAVI.K
  2. 2. HISTORY IN BRIEF <ul><li>27 YR OLD FEMALE P2L2A2 WITH C/O BREATHLESSNESS AT REST ON/OFF FOR 1 MONTH. </li></ul><ul><li>C/O SWELLING OF LEGS FOR 20 DAYS. </li></ul><ul><li>COUGH WITH EXPECTORATION FOR 15 DAYS. </li></ul><ul><li>CONDITION: PALLOR, BPPE+,B/L CREPTS+, SM + TA. </li></ul>
  3. 4. INTERPRETATION <ul><li>12 leaded ecg showing a complete heart block-AV DISSOCIATION </li></ul><ul><li>Atrial rate-100:ventricular rate:67-68/min </li></ul><ul><li>RAD </li></ul><ul><li>PR INTERVAL CANNOT BE COMMENTED </li></ul><ul><li>QRS-BROAD N WIDE </li></ul><ul><li>RBBB LIKE,ST DEPRESSION N T INVERSION V1-V4. </li></ul>
  4. 6. Rhythms Produced by Conduction Block <ul><li>AV Block (relatively common) </li></ul><ul><ul><li>1 st degree AV block </li></ul></ul><ul><ul><li>Type 1 2 nd degree AV block </li></ul></ul><ul><ul><li>Type 2 2 nd degree AV block </li></ul></ul><ul><ul><li>3 rd degree AV block </li></ul></ul><ul><li>SA Block (relatively rare) </li></ul>
  5. 7. Causes <ul><li>Ischemic heart disease, cardiomyopathy and degenerative changes </li></ul><ul><li>Drugs that depress AV conduction,DIGITALIS TOXICITY </li></ul><ul><li>Myocardial infarction, infiltration (e.g., tumor) </li></ul><ul><li>Trauma (e.g., surgery; therapeutic ablation) </li></ul><ul><li>Lev disease : fibro calciferous involving aortic valve extending to conducting sys </li></ul><ul><li>Lenegres disease: sclero degenarative process involving conducting system </li></ul><ul><li>CHAGAS DISEASE </li></ul><ul><li>Congenital abnormalities </li></ul>
  6. 8. Congenital Acquired <ul><li>ISOLATED </li></ul><ul><li>HEREDITARY </li></ul><ul><li>CONNECTIVE TISSUE </li></ul><ul><li>QRS 40-50 bpm </li></ul><ul><li>QRS DURATION NORMAL </li></ul><ul><li>RATE ^WITH ATROPINE </li></ul><ul><li>PROXIMAL BLOCK </li></ul><ul><li>PACE MAKER MANDATORY </li></ul><ul><li>IWMI/AWMI </li></ul><ul><li>LEVE’S </li></ul><ul><li>LENEGRE </li></ul><ul><li>QRS 20-30bpm </li></ul><ul><li>PROLONGED </li></ul><ul><li>NOT SO </li></ul><ul><li>DISTAL </li></ul><ul><li>NOT SO </li></ul>
  7. 9. FIRST-DEGREE HEART BLOCK <ul><li>OCCURS WHEN THERE IS A PARTIAL INTERRUPTION ANYWHERE IN THE ATRIAL OR AV JUNCTIONAL CONDUCTION SYSTEM. </li></ul><ul><li>THE IMPULSE IS EVENTUALLY CONDUCTED BUT IS DELAYED. </li></ul><ul><li>EKG Characteristics: Prolongation of the PR interval, which is constant </li></ul><ul><li>All P waves are conducted </li></ul>
  8. 10. MOBITZ I HEART BLOCK <ul><li>MOBITZ I ( WENCKEBACH OR SECOND-DEGREE HEART BLOCK, TYPE I). </li></ul><ul><li>PROGRESSIVE BLOCK. </li></ul><ul><li>IMPULSE FROM THE ATRIA IS INTERRUPTED AT THE AV JUNCTION. </li></ul><ul><li>(1)The P-R interval becomes longer and longer (2)The R-R interval gets shorter and shorter. </li></ul><ul><li>THE INTERRUPTION BECOMES LONGER WITH EACH IMPULSE DELAYING DEPOLARIZATION OF THE VENTRICLES UNTIL A COMPLETE INTERRUPTION BLOCKS THE IMPULSE. </li></ul>
  9. 11. II Block P P P P P Second Degree AV Block - Type I (Wenkebach or Mobitz I Block)
  10. 12. MOBITZ II HEART BLOCK <ul><li>OCCURS DUE TO AN INTERMITTENT INTERRUPTION NEAR OR BELOW THE AV JUNCTION. </li></ul><ul><li>INTERRUPTION IS NOT PROGRESSIVE, BUT OCCURS SUDDENLY </li></ul><ul><li>P WAVES BEFORE EVERY QRS COMPLEX AND ALL ARE THE SAME SIZE AND SHAPE. </li></ul>
  11. 13. Second Degree AV Block - Type II P P P P P Block
  12. 14. THIRD-DEGREE HEART BLOCK <ul><li>COMPLETE HEART BLOCK OR COMPLETE AV DISSOCIATION. </li></ul><ul><li>IMPULSE IS COMPLETELY BLOCKED BETWEEN THE ATRIA AND THE VENTRICLES. </li></ul><ul><li>USUALLY TAKES PLACE BETWEEN THE AV JUNCTION AND BUNDLE OF HIS. </li></ul><ul><li>1).The atrial and the ventricular rhythms are absolutely </li></ul><ul><li>independent of one another . 2).There is no P-R to QRS relationship. 3).The atrial rate is more rapid than the ventricular rate. 4).regular P-P interval . 5).rugular R-R interval </li></ul>
  13. 15. 3 rd Degree (Complete) AV Block EKG Characteristics: No relationship between P waves and QRS complexes Relatively constant PP intervals and RR intervals Greater number of P waves than QRS complexes www.uptodate.com
  14. 16. MANAGEMENT <ul><li>1 ST DEGREE BLOCK – ASSESS AND MONITOR THE PATIENT. </li></ul><ul><li>MOBITZ I ( 2 ND DEGREE, TYPE I) – USUALLY DOES NOT REQUIRE TREATMENT, BUT IF THE PATIENT IS MEDICALLY UNSTABLE OR POOR CARDIAC OUTPUT ATROPINE IS USED IF THE OVERALL RATE IS BRADYCARDIC. </li></ul><ul><li>MOBITZ II (2ND DEGREE, TYPE II) – OXYGEN, IV FLUIDS,ATROPINE IF OVERALL RATE IS BRADYCARDIC, ARTIFICIALPACEMAKER, DOPAMINE OR EPINEPHRINE. </li></ul><ul><li>IF HEART RATE IS GREATER THAN 100 BUT LESS THAN </li></ul><ul><li>150 DILTIAZEM, DIGOXIN, OR BETA BLOCKERS. </li></ul><ul><li>3RD DEGREE BLOCK – OXYGEN, IV FLUIDS, ATROPINE IFBRADYCARDIC, DOPAMINE, EPINEPHRINE, OR ARTIFICIALPACEMAKER. </li></ul>
  15. 17. THANK YOU

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