Blocks Flashcards
song for first degree AV block
if the R is far from the P, then you have a first degree
song for wenckebach
longer, longer, longer drop, then you have a wenckebach
song for mobitz II
if some P’s just don’t get through, then you have a Mobitz II
song for third degree AV block
If P’s and Q’s just don’t agree, than you have a third degree
what are the S&S of a first degree AV block?
none
what is the treatment for a first degree AV block?
none needed
what are 3 symptoms of a wenckebach?
bradycardia
angina
syncope
what is the treatment for wenckebach?
treat bradycardia - stop AV block meds
where is the block in a wenckebach?
within AV node
where is the block in a mobitz type II?
below the AV node in the His Bundle
what symptom, if any, would be present in a mobitz type II?
bradycardia
what is the treatment for a mobitz type II AV block?
pacemaker
treat bradycardia
a mobitz type II AV block usually occurs in the presence of what?
bundle branch block
what can mobitz type II AV block lead to?
stokes-adams attacks
how are third degree AV blocks characterized?
independent atrial and ventricular complexes
what must be present to diagnose a third degree AV block?
ventricular rate that is slower than the atrial rate
what are S&S of a third degree AV block? (5)
bradycardia
palpitations
angina
dyspnea
stokes-adams attacks
what is the treatment for a third degree AV block?
treat bradycardia
pacemaker
what does a left bundle branch block always indicate?
cardiac disease
what are the two tests for a BBB?
ECG, then holter monitor
what is the recommended treatment for patients with bifascicular block?
pacemaker
what medication can be used to treat a LBBB?
beta blockers
what treatment is recommended for a patient with BBB with depressed systolic function, heart failure, and QRS > 0.12 sec?
cardiac resynchronization therapy (surgical)
what would be seen on ECG for a RBBB? (2)
wide QRS complex
rabbit ears in V1 or V2
what would be seen on ECG for a LBBB? (2)
wide QRS complex
notched wave in lead V5 or V6
an ECG containing a LBBB cannot be evaluate for what? (3)
ischemia
infarction
ventricular hypertrophy
where would reciprocal changes be seen in RBBB?
I, aVL, V5, and V6
in which 2 blocks could right axis deviation occur?
RBBB
Left posterior fascicular block
in which 2 blocks could left axis deviation occur?
LBBB
Left anterior fascicular block
what is it called when half of LBBB is blocked after it splits into left anterior and left posterior fascicles?
hemiblock
what is the criteria for left anterior fascicular block?
LAD -30 to -90 degrees
what is the criteria for left posterior fascicular block? (1)
RAD 90 - 180 degrees
LAFD + LPFB =
LBBB
RBBB + LAFB + LPFB =
third degree AV block
what is a RBBB + LPFB ?
bifascicular block
a 16 year old patient mother state’s he has been feeling lightheaded. There are associated palpitations and like “my heart is leaping out of my chest”. Vitals are normal. On ECG, you see decreased PR intervals and delta waves. what is this suspicious for?
wolff-parkinson white
what is the bypass pathway for WPW?
bundle of kent
what can WPW lead to? (3)
atrioventricular reentrant tachycardia
atrial fibrillation
v fib
what is the main cause of WPW?
congenital
accessory pathways that represent the remnants of failed fusion of AV junctional tissue
bundle of kent
what are 2 diagnostics used for WPW?
radiofrequency catheter ablation
event monitor
what causes the delta wave?
Kent bundle, depolarizing the ventricular muscle earlier
AVRT pathway that is antegrade (down to ventricles) through AV node and retrograde (up to the atria) via the AV accessory pathway
Orthodromic AVRT
what would orthodromic AVRT look like on ECG? (2)
narrow QRS
inverted P waves
150-250 b/min
AVRT pathway that goes through kent bundle and into AV node
antidromic AVRT
what would an antidromic AVRT look like on ECG? (2)
wide QRS
inverted P waves
what is the first line acute treatment for orthodromic AVRT?
vagal maneuvers
what is the first line acute treatment for antidromic AVRT?
IV procainamide
what is the first line treatment for pre-excited atrial fibrillation?
IV ibutilide or IV procainamide
what is the chronic prevention for orthodromic AVRT, antidromic AVRT, and pre-excited atrial fibrillation?
catheter ablation of accessory pathway
what should all unstable patients get as treatment, especially pre-excited atrial fibrillation?
synchronized cardioversion
