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Heart blocks

QuestionAnswer
First degree heart block Start of P to start of R wave PR interval > 200ms (5 small squares)
2nd degree mobitz 1 Wencheback Progressive prolongation of the PR interval culminating in a non-conducted P wave. (QRS dropped)
Mobitz 1 Wencheback features P-P interval remains relatively constant The RR interval progressively shortens witj each beat of cycle Wencheback pattern tends to reprat in P:QRS with ratio 3:2, 4:3 or 5:4
Causes of Wenckeback Drugs- beta blocker, CCB, Digoxin, Amiodarone Increase vagal tone Inferior MI Myocarditis
2nd degree mobitz type 2 A form of 2nd degree AV block in which there is intermittent non-conductive P waves without progressive prolongation of the PR interval
Features of mobitz type 2 PR interval in conducted beats remains constant. The P waves march through at constant rate. The RR interval surrounding the dropped beat is an exact multiple of the preceding RR interval
Mobitz t2 mechanism Usually due to a failure of the His-Purkinje system- below AV node There may be no pattern to conduction blockade, or may be fixed 2:1, 3:1 Typically have pre- existing LBBB or bifasicular block
Causes of mobitz 2 Drugs- beta-blockers, CCB, Digoxin, Amiodarone Inflammatory - rheumatic fever, myocarditis Autoimmune - SLE, systemic sclerosis Hyperkalaemia
Mobitz T2 clinical significance More likely to have haemodynamic compromise, severe bradycardia and progress to 3rd degree HB. Stoke-Adams attacks Mobitz 2 mandates cardiac monitoring and pacemaker
3rd degree AV block Severe bradycardia due to absence of AV conduction Complete AV dissociation with independent atrial and ventricular rates
Causes of complete heart block Inferior MI AV nodal blocking drugs- CCB, Beta blocker, Digoxin Idiopathic degeneration of conduction system causing true trifascicuar block
3rd degree clinical significance High risk of ventricle standstill and sudden cardiac death Require pacing and insertion of pacemaker
Created by: Lrav27
 

 



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