Clinical: Heart Block Flashcards
What kind of HB is this?
- Third degree
- P wave can be buried in a QRS complex
- Each P to P interval is =
- Each R to R interval is =
- In Prolonged Sinus Node Dysfunction from conditions like A-fib, what can occur to the AV node?
Increased Vagal Tone
For normal cardiac conduction
- Normal QRS duration < ____ (ms)
In Delayed Signals in the Ventricle
- Depolarization of ventricles will take ________
- QRS > ____ ms
- QRS axis may change
- QRS vector will be shifted in a direction of the ____ part of ventricles to be ____________
For normal cardiac conduction
- Normal QRS duration < 100 (ms)
In Delayed Signals in the Ventricle
- Depolarization of ventricles will take longer
- QRS > 100 ms
- QRS axis may change
- QRS vector will be shifted in a direction of the last part of ventricles to be depolarized
What is the common symptom of Sinoatrial exit block, and how is it usually treated?
Syncope
Pacemaker
What are two parasite-related diseases that can cause HB?
- Lyme Disease
- Creates 1st to 3rd degree HB
- Resolves in most PTs even if untreated for Lyme Disease
- HB may actually be 1st sign of Lyme Disease
- Chagas Disease
- From a parasite from Latin America
- Can cause all types of Hb
What is sinus arrhythmia, and in which PT population is this condition considered “normal”?
RR intervals are not equal
What type of HB is this?
Left BBB
What type of HB is this?
2nd-degree type 1
What kind of heart block is this?
- Is this normal, left BBB, or right BBB?
- Left is from V1
- Right is from V6
- Right BBB
- V1 Ravvit Ears
- V6 S wave slurring
What type of HB is this?
right BBB
What type of HB is this?
1st degree
Fill in the blank
- What is the bpm for an Idioventricular Escape Rhythm?
- What region of the ventricle does this occur, and how do you know?
- When does this type of beat occur?
Is this a Right BBB or a left BBB? How can you tell?
V1 has rabbits ears and a slurred S wave in V6
What type of HB is this?
Describe a Second Degree Type II HB
- What happens to the PR interval?
- Where is this block usually located?
- What is the Tx?
What type of HB is this?
2nd degree type 2 WITH a R BBB
What is a Bifascicular Block?
What artery supplies the anterior wall of the heart?
Left anterior descending artery supplies anterior wall and can cause bundle branch block and second and third-degree block
What kind of HB is this?
What is indicative of all second-degree heart blocks?
Dropped QRS complexes, so not a 1:1 ratio from P waves:QRS complexes
What does a right BBB look like?
“Rabbit Ears”
Describe the different types of Pacings that are used to treat HB
- Emergent Pacing
- Electric current through the chest wall to reach the heart
- PAINFUL
- Temporary Pacing
- Use a central line to reach the right side of the heart with wires
- Permanent Pacing
What are the parameters for an incomplete heart block and a complete heart block?
- Incomplete
- Between 100 bpm and 120 bpm
- Complete
- > 120 ms (3 boxes)
What type of HB is this?
3rd degree
What do you see in V1 and V6 in right BBBs?
- V1
- rabbits ears
- V6
- Slurred S-wave
What artery usually supplies the AV node?
Right coronary artery
What is the treatment for an HB that is caused by MI or ischemia?
- How do you treat HBs with meds?
- Compare the Tx for an AV node block vs a block at the His bundle or more distal areas
Is this normal, left BBB, or right BBB?
- Left is from V1
- Right is from V6
- Left BBB
- Pen tip in both V1 and V6
What type of HB is this?
Is this a Right BBB or a left BBB? How can you tell?
- How do you know this is an AV junctional rhythm?
- What should the bpm be for this condition?
What type of HB is this?
What can we classify an AV junctional rhythm as?
An escape Rhythm [the AV Node signal travels backwards]
What does a left BBB look like?
What are the non-Rx causes of HB?
Describe a second-degree Type I Wenckebach HB
- What happens to the PR interval?
- What heart structure is this type of block most likely near?
- What is the tx for this?
- Probably near the AV node
Describe a third-degree HB aka Complete Heart Block
- What is the relationship b/w the atria and ventricles?
- Where does the QRS/ventricular depolarization originate?
- What is the Tx?
What kind of heart block is this and how would you treat it?
- First-Degree
- This in isolation of other conditions do not require treatment
What is a defining feature of Junctional Tachycardia?
Retrograde P waves
What is a Sinoatrial exit block?
The exit of the impulse from the sinus node is blocked, so no P-wave
Which type of BBB can be seen in normal healthy young people?
Right
Is this a right BBB or left BBB? How can you tell?
Left BBB
- Is this normal, left BBB, or right BBB?
- Left is from V1
- Right is from V6
Normal
- What condition does an Accelerated Idioventricular Rhythm look like?
- What do avoid when if you see this rhythm?
- Like a slow V-Tach
- HR under 100
- Avoid any nodal blockers or HR suppressors
What is the only “normal” way that an electrical signal should travel from the atria to the ventricle?
AV Node
- How long does a narrow QRS complex last and how long does a wide QRS complex last?
- Where does the wide complex usually occur?
- Is a right or left BBB usually considered a marker of underlying heart disease and degeneration of the conducting system?
- List the various diseases it is associated with
- Describe what a first-degree block is
- What happens to the PR interval
- Where can it occur?
- Compare the P-waves to the QRS complexes
Describe Secondary Pacemakers and Escape Rhythms, including bpms
- What is a “sick sinus syndrome”?
- Sick sinus syndrome is a relatively uncommon heart rhythm disorder. SSS is not a specific disease, but rather a group of signs or symptoms that indicate the sinus node, the heart’s natural pacemaker, is not functioning properly.
- The dysfunctional impulse is probably not originating at the SA Node.
What type of diseases are normally associated with right BBBs?
- Pulmonary Diseases
- Atrial septal defects
What type of HB is this?
2nd degree type 2
What type of HB is this?
4:3 ratio
What type of HB is this?
2nd degree type 1
What are the types of medications that can cause HR?
