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Gen Med Unit 7a: Cardio 2 > AV and BB Blocks > Flashcards

AV and BB Blocks Flashcards

1
Q

Define av block

A
  1. Delay or interruption in the transmission of impulse from the atria to the ventricles due to an anatomical or functional impairment in the conduction system
  2. Conduction disturbance can be transient or permanent
  3. Conduction can be delayed, intermittent, or absent
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2
Q

What are the characteristics of 1st degree AV block?

A
  1. Conduction delay in the atrium, AV node, or bundle of His
  2. Generally benign
  3. PR interval >.20 sec
  4. Slowed conduction without missed beats
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3
Q

What are the causes of 1 st degree AV block?

A 
1. Most common → block in 2. AV node
Causes:
A. ↑ Vagal tone 
B. CCB’s
C. Digoxin 
D. ß-blockers
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4
Q

What is another name for 2nd Degree AV Block Mobitz Type I?

A
  1. Wenckebach
    A. Progressive PR interval prolongation for several beats preceding the nonconducted P wave

B. May be transient or temporary

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5
Q

When is Wenckebach treated? How is it treated?

A
  1. Treat ONLY if symptomatic
  2. If pt on beta blocker, CCB, or digoxin, ↓ dose
  3. If pt not on above meds, consider temporary or permanent pacemaker
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6
Q

What are the sxs of wenckebach?

A
  1. Due to bradycardia
    A. CP, SOB, ↓ level of consciousness
    B. Hypotension, shock, pulmonary congestion, CHF, angina
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7
Q

What is a Mobitz type II AV block?

A

PR interval remains unchanged prior to a P wave that suddenly fails to conduct to the ventricles

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8
Q

What are the complications of mobitz type 2?

A

Almost always permanent and frequently progresses to complete heart block

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9
Q

What are the causes of Mobita type 2?

A
  1. Myocardial ischemia
  2. ↑ Vagal tone
  3. Drugs that depress conduction
  4. Almost always due to organic disease involving infranodal conduction system
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10
Q

What are the sxs of mobitz type 2?

A
  1. Due to bradycardia
    A. CP, SOB, ↓ level of consciousness
    B. Hypotension, shock, pulmonary congestion, CHF, angina
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11
Q

What is the treatment of mobitz type 2?

A

Prepare for permanent pacer

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12
Q

What is a 3rd degree av block?

A
  1. Complete heart block
  2. No atrial impulses reach the ventricles
  3. Block can exist in the AV node or infranodal conduction system
  4. The more distal the block, the slower will be the escape pacemaker
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13
Q

What are the sxs of 3rd degree block?

A
  1. Due to bradycardia
    A. CP, SOB, syncope (Stokes-Adams Attacks)
    B. Hypotension, CHF, angina, MI, V. Tach, V. Fib
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14
Q

How is 3rd degree AV block treated?

A
  1. Correct reversible causes (meds, ischemia)
  2. Atropine can partially or completely restore conduction when complete heart block induced by acute IWMI
  3. Permanent pacemaker
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15
Q

PR interval is constant. There is a sudden non-conducted P wave. This describes:

A

. 2nd degree AV block, Mobitz Type II

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16
Q

PR interval > 0.20 sec describes this type of block:

A

1st degree AV block

17
Q

No P waves are conducted to produce QRS complexes. QRS complexes represent escape rhythm.

A

. 3rd degree AV block

18
Q

PR interval gets progressively longer and then a QRS is dropped. This describes which of the following?

A

2nd degree AV block, Mobitz Type I

19
Q

define sick sinus syndrome

A

Sick sinus syndrome comprises a variety of conditions involving sinus node dysfunction
Commonly affects elderly

20
Q

What are the causes of SSS?

A
  1. Usually idiopathic

A. Can be 2° digoxin, CCB, beta blockers, anti-arrhythmic drugs

21
Q

What are the sxs of sss?

A
  1. Pts may experience syncope, pre-syncope, palpitations, or dizziness
    A. Often are asymptomatic or subtle/nonspecific symptoms
22
Q

What are the EKG findings for SSS?

A 
1. Multiple manifestations on EKG
A. Sinus bradycardia 
B. Sinus arrest 
C. Sinoatrial block  
D. Alternating patterns of bradycardia and tachycardia (bradycardia-tachycardia syndrome)
23
Q

Why is dx of SSS difficult?

A

Diagnosis can be difficult due to nonspecific symptoms and elusive findings on EKG or Holter monitor

24
Q

How is SSS treated?

A
  1. The mainstay of treatment is pacemaker placement

A. Generally provides effective relief of symptoms

25
Q

What are bundle branch blocks caused by?

A
  1. Caused by a block of the impulse of the right or left Bundle Branch
  2. One ventricle depolarizes slightly later than the other, resulting in a widened QRS
    A, In Right Bundle Branch Block, the right ventricle depolarizes late
    B. In Left Bundle Branch Block, the left ventricle depolarizes late
26
Q

Who is at risk for LBBB?

A
  1. Common in pts with normal and diseased hearts
    A. Ischemic heart disease, cardiomyopathy, inflammatory heart disease
    B. LBBB has higher incidence of overt heart disease
27
Q

What are the general EKG findings for BBB?

A

If the QRS ≥ 0.12 sec,

Look for R-R’ waves

28
Q

What leads do you check for RBBB?

A

Check V1 & V2 (right chest leads)

If QRS ≥ 0.12 sec

29
Q

What leads do you check for LBBB?

A

Check V5 & V6 (left chest leads)

30
Q

What is RBBB asst with?

A 
1. Associated with several types of structural heart disease
A. Cor pulmonale 
B. PE 
C. Myocardial ischemia/infarction
D. Myocarditis 
E. HTN 
F. Congenital heart disease
G. Incidence increases w/ age
31
Q

What is LBBB asst with?

A
  1. Incidence increases w/age
  2. Results from slowly progressive degenerative disease involving the conduction system
  3. May be functional
  4. Associated with higher short-term and long-term mortality following MI
  5. Risk factor for mortality in patients with heart failure and is assoc. w/ ↑ all-cause mortality and sudden death @ 1 year
  6. May result following acute myocardial insult
    A. Myocardial ischemia
    B. MI
    C. Myocarditis
32
Q

What are the EKG characteristics of LBBB?

A
  1. If QRS ≥ 0.12 sec, check V5 & V6 (left chest leads) for two R waves
    A. Broad notched or slurred R wave in leads I, aVL, V5, & V6
    B. T waves usually inverted in I, aVL, V5, V6
    C. Predominantly negative QRS in V1, V2, V3
33
Q

True/False: If LBBB present, infarct cannot be accurately diagnosed on an EKG

A

True

34
Q

How can a LBBB pt be evaluated?

A

Nuclear stress test

Stress echo

Gen Med Unit 7a: Cardio 2 (8 decks)

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