2. AV Block
Partial delays or complete
interruptions in the cardiac conduction
pathway between the atria and
ventricles
The degree of block defines the type
and classification of heart block
2
3. AV Block
Common causes:
◦ Ischemia
◦ Myocardial necrosis
◦ Degenerative disease of the conduction
system
◦ Congenital anomalies
◦ Drugs (especially digitalis preparations)
3
4. AV Block
1st-degree AV heart block
2nd-degree AV heart block, Mobitz
type I (Wenckebach)
2nd-degree AV heart block, Mobitz
type II
3rd-degree AV heart block
4
9. 2nd-Degree AV Heart Block,
Mobitz Type I
Intermitt
ent block
at the
level of
the AV
node
Also
referred
to as
Wencke
bach
12
10. 2nd-Degree AV Heart Block,
Mobitz Type I
More P waves than QRS complexes
and the rhythm has patterned
irregularity
PR interval increases until a QRS
complex is dropped
After dropped beat the next PR
interval is shorter
As each subsequent impulse
generated there is a progressively
longer PR interval until again, a QRS
is dropped
13
12. 2nd-Degree AV Heart Block,
Mobitz Type II
Intermitten
t block at
the level of
the bundle
of His or
bundle
branches
resulting in
atrial
impulses
that are
not
conducted
to the 16
The normal PR interval is 0.12 to 0.20 seconds in duration.
The normal PR interval is 0.12 to 0.20 seconds in duration.
3
2.1
Mobitz 2
Severe 1 degree
Atrial rate 56 BPM, Ventricular rate 56 BPM, regular rhythm, P waves are upright and normal and each is followed by a QRS complex, QRS complexes are normal at 0.08 seconds in duration, PRI has a longer than normal duration 0.30 seconds, QT 0.40 seconds. Sinus bradycardia with 1st-degree AV heart block.
Answer: Atrial rate 60 BPM, Ventricular rate 50 BPM, patterned irregularity, normal and upright P waves but not all are followed by a QRS complex, normal QRS complexes at 0.08 seconds, PRI is progressively longer until a QRS complex is dropped and then the cycle starts over again, QT 0.40 seconds. 2nd-degree AV heart block, type I.
Answer: 50 BPM (ventricular) 84 BPM (atrial), regular rhythm, P waves are upright and normal but there are more P waves than QRS complexes, QRS complexes are bizarre-looking and wide at 0.20 seconds in duration, PRI is immeasurable (as the P waves are not associated
with the QRS complexes), the P waves appear to march through the QRS complexes, QT 0.48 seconds. 3rd-degree AV heart block.
Answer: Atrial rate 58 BPM, Ventricular rate 60 BPM, regular rhythm, P waves are upright and normal and each is followed by a QRS complex, QRS complexes are normal at 0.12 seconds in duration, PRI has a longer than normal duration 0.30 seconds and constant, QT 0.40 seconds. Sinus bradycardia with 1st-degree AV heart block.
Answer: Atrial rate 94 BPM, Ventricular rate 48 BPM, regular rhythm, P waves are upright and normal but there are two P waves preceding each QRS (in other words, not all the P waves are followed by a QRS complex), QRS complexes are normal at 0.08 seconds in duration, PRI 0.16 seconds and is constant for the conducted beats, QT 0.36 seconds. 2nd-degree AV heart block, type II.
Answer: Atrial rate 75 BPM, Ventricular rate 36 BPM, regular rhythm, P waves are upright and normal but there are more P waves than QRS complexes, QRS complexes are bizarre-looking and wide at 0.16 seconds in duration, PRI is immeasurable (as the P waves are not associated with the QRS complexes), the P waves appear to march through the QRS complexes, QT 0.36 seconds. 3rd- degree AV heart block.
Answer: Atrial rate 45 BPM, Ventricular rate 45 BPM, regular rhythm, normal and upright P waves and each is followed by a QRS complex, QRS complexes at 0.08 seconds, PRI 0.44 seconds and constant, QT 0.48 seconds. Sinus bradycardia with 1st-degree AV heart block.
Answer: Atrial rate 94 BPM, Ventricular rate 48 BPM, regular rhythm, P waves are upright and normal but there are two P waves preceding each QRS (in other words, not all the P waves are followed by a QRS complex), QRS (more accurately described as RS) complexes are
0.08 seconds in duration, PRI 0.24 seconds and is constant for the conducted beats, QT 0.36 seconds. 2nd-degree AV heart block, type II (there is also a 1st degree AV block).
mobitz1
Answer: Atrial rate 115 BPM, Ventricular rate 42 BPM, regular rhythm, P waves are upright and normal but there are more P waves than QRS complexes, QRS complexes are normal at 0.12 seconds in duration, PRI is immeasurable (as the P waves are not associated with the QRS complexes), the P waves appear to march through the QRS complexes, QT 0.44 seconds. 3rd-degree AV heart block.