Heart Blocks!

Question 1

what is a HEART BLOCK?

Answer 1

HEART BLOCK is when electrical impulses don’t conduct properly

Question 2

what happens during 1st DEGREE HEART BLOCK?

Answer 2

**all sinus impulses reach the ventricles; ultimately harmless

Question 3

what does 1st DEGREE HEART BLOCK look like on EKG strip?

Answer 3

**P WAVE looks normal = harmless

–If you measure PR INTERVAL, it WILL be greater than 0.20 seconds

Question 4

what causes 1st DEGREE HEART BLOCK?

Answer 4

• MI
• CAD
• fever
• HYPERthyroidism
• electrolyte imbalance: HYPOkalemia
• vagal stimulation
• drugs

Question 5

how do I help with treating my patients 1st degree heart block?

Answer 5

• *asyptomatic? = NO INTERVENTION NEEDED

- -continue to monitor/document incase it worsens into more serious blocks

Question 6

what happens during 2nd DEGREE HEART BLOCK - TYPE 1 (wenekebach)

Answer 6

**some impulses reach the ventricles, until eventually there is no impulse conducted

Question 7

what does 2nd DEGREE HEART BLOCK-T1 look like on EKG strip?

Answer 7

**gradual lengthening of PR interval until QRS is dropped!

“longer, longer, longer, DROP, then you have wenekebach”

**QRS complex missing

**P > P INTERVAL & R > R INTERVAL NOT REGULAR!!!

Question 8

what will be my patients S/S of 2nd DEGREE HEART BLOCK-T1?

Answer 8

• dizziness
• lightheadedness
• chest pain
• HYPOtension
• ASYMPTOMATIC

Question 9

how can I help treat my patients 2nd DEGREE HEART BLOCK-T1?

Answer 9

• **ATROPINE; max 3 mg:
  0. 5mg bolus, Q 3-5 min until max 3mg has been reached!

—if medications don’t help, might have to offer temporary pacemaking/transq pacing!

Question 10

what happens during 2nd DEGREE HEART BLOCK - TYPE 2

Answer 10

AV node is NOT conducting all of the P WAVE

Question 11

what does 2nd DEGREE HEART BLOCK - T2 look like on EKG strip?

Answer 11

**PR interval IS CONSISTENT; there is NO growing interval;

QRS COMPLEX IS STILL DROPPED

Question 12

what will my patients S/S be with 2nd DEGREE HEART BLOCK - T2?

Answer 12

• ***THIS OFTEN PROGRESSES TO COMPLETE HEART BLOCK!
• HYPOtension
• myocardial ischemia
• syncope (fainting)

Question 13

should I give ATROPINE to my patient with 2nd DEGREE HEART BLOCK - T2?

Answer 13

NO!!!

Question 14

how can I help treat 2nd DEGREE HEART BLOCK - T2?

Answer 14

PACING!!!

• transq pacemaker
• temporary pacemaker
• *permanent pacemaker might eventually be necessary

Question 15

what happens in 3rd DEGREE HEART BLOCK?

Answer 15

**complete disassociation between SA & AV nodes;

SA is releasing impulses BUT AV node is ALSO releasing impulses; everyone is doing their own thing!!!!

Question 16

what does 3rd DEGREE HEART BLOCK look like on EKG strip?

Answer 16

P > P intervals = regular
QRS complex = regular
BUT there is NOT a P WAVE before every QRS complex!

Question 17

what S/S will my patient be experiencing with 3rd DEGREE HEART BLOCK?

Answer 17

• **HR could be in the 20s!
• reduced cardiac output
• HYPOtension
• chest pain + ischemia
• shock
• syncope (fainting)
• change in LOC

Question 18

should I give my HEART BLOCK patient BETA BLOCKERS?

Answer 18

ABSOLUTELY NOT!!! you DO NOT block a block!!!!

Question 19

what can I do to help my patient experiencing 3rd DEGREE HEART BLOCK??

Answer 19

START PACING!!!!!: think pacemaker, temporary and permenant!!

Question 20

what is important to know about pacemakers?!

Answer 20

***PACEMAKERS work on the demand: sense + respond to what is needed by the heart!

Question 21

PACEMAKERS: temporary, invasive, permanent

Answer 21

TEMPORARY PACEMAKERS - think EMERGENT situations
INVASIVE PACEMAKERS - think URGENT
PERMANENT PACEMAKERS - think CHRONIC

Question 22

what does a PACEMAKER look like on EKG strip?

Answer 22

there will be SPIKES on EKG strip before PQRST, this SPIKE is the firing of the PACEMAKER!

Question 23

what education does the patient need to be provided with following PACEMAKER placement?

Answer 23

**teach patient how to check their pulse + document how pacemaker is functioning

• –DO NOT lift arm for 3-7 days following placement!
• -NO heavy lifting
• -AVOID magnets