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28 views26 pages

Module 4cecg

Uploaded by

m4mv5zrfcc
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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ECG Rhythm Interpretation

Module IV c

AV Junctional Blocks
Course Objectives

• To recognize the normal rhythm of the


heart - “Normal Sinus Rhythm.”
• To recognize the 13 most common
rhythm disturbances.
• To recognize an acute myocardial
infarction on a 12-lead ECG.
Learning Modules

• ECG Basics
• How to Analyze a Rhythm
• Normal Sinus Rhythm
• Heart Arrhythmias
• Diagnosing a Myocardial Infarction
• Advanced 12-Lead Interpretation
Arrhythmias

• Sinus Rhythms
• Premature Beats
• Supraventricular Arrhythmias
• Ventricular Arrhythmias
• AV Junctional Blocks
AV Nodal Blocks

• 1st Degree AV Block


• 2nd Degree AV Block, Type I
• 2nd Degree AV Block, Type II
• 3rd Degree AV Block
Rhythm #10

• Rate? 60 bpm
• Regularity? regular
• P waves? normal
• PR interval? 0.36 s
• QRS duration? 0.08 s
Interpretation? 1st Degree AV Block
1st Degree AV Block

• Deviation from NSR


– PR Interval > 0.20 s
1st Degree AV Block

• Etiology: Prolonged conduction delay in


the AV node or Bundle of His.
Rhythm #11

• Rate? 50 bpm
• Regularity? regularly irregular
• P waves? nl, but 4th no QRS
• PR interval? lengthens
• QRS duration? 0.08 s
Interpretation? 2nd Degree AV Block, Type I
2nd Degree AV Block, Type I

• Deviation from NSR


– PR interval progressively lengthens,
then the impulse is completely blocked
(P wave not followed by QRS).
2nd Degree AV Block, Type I

• Etiology: Each successive atrial impulse


encounters a longer and longer delay in
the AV node until one impulse (usually
the 3rd or 4th) fails to make it through
the AV node.
Rhythm #12

• Rate? 40 bpm
• Regularity? regular
• P waves? nl, 2 of 3 no QRS
• PR interval? 0.14 s
• QRS duration? 0.08 s
Interpretation? 2nd Degree AV Block, Type II
2nd Degree AV Block, Type II

• Deviation from NSR


– Occasional P waves are completely
blocked (P wave not followed by QRS).
2nd Degree AV Block, Type II

• Etiology: Conduction is all or nothing


(no prolongation of PR interval);
typically block occurs in the Bundle of
His.
Rhythm #13

• Rate? 40 bpm
• Regularity? regular
• P waves? no relation to QRS
• PR interval? none
• QRS duration? wide (> 0.12 s)
Interpretation? 3rd Degree AV Block
3rd Degree AV Block

• Deviation from NSR


– The P waves are completely blocked in
the AV junction; QRS complexes
originate independently from below the
junction.
3rd Degree AV Block

• Etiology: There is complete block of


conduction in the AV junction, so the
atria and ventricles form impulses
independently of each other. Without
impulses from the atria, the ventricles
own intrinsic pacemaker kicks in at
around 30 - 45 beats/minute.
Remember
• When an impulse originates in a ventricle,
conduction through the ventricles will be
inefficient and the QRS will be wide and
bizarre.
AV blocks or atrio – ventricular blocks or heart rate
: block

.A. there is a delay in conduction of impulses in the AV node


.B. rhythm maybe irregular
C. PR interval is longer than .20 second. ( normal PR interval
is .12 - .20 second )
.D. there are three kinds of AV block
: 1st degree AV block -1
.a. rhythm is regular
b. PR interval is more than0.20second & is constant
.throughout the rhythm strip
c. QRS complex is normal ( .06 - .12 second )
: 2nd degree AV block has tow type -2

.a. 2 AVB type 1 is also called wenckebach or mobitz 1


.b. 2 AVB type 2 is also called as mobitz 2
.c. rhythm maybe irregular for 2nd degree AVB type 1 & type 2

: 2nd degree AVB type 1


.is also called wenckebach or mobitz 1 -1
. rhythm maybe irregular -2
QRS complex is normal ( .06 - .12 second ) -3
first PR interval may be normal or longer than 0.20 -4
.second
second PR interval maybe as long as the first PR -5
.interval or it may be longer
third PR interval maybe longer than second PR -6
.interval
.PR interval maybe longer than third PR and -7
then you will see a drop in heart beat, no P wave nor -8
.QRS
then the heart picks up again & you may find the same -9
sequence of the conduction as mentioned from number
.1 – 7
: 2nd degree AVB type 2
.is also know as mobitz 2 -1
.rhythm maybe irregular -2
.PR interval is either normal or longer than 0.20 -3
PR interval is constant when conducted ( when there is a -4
QRS complex )
QRS complex is normal (0.06 – 0.12) -5
.there are more P wave than QRS complex -6
: 3rd degree AV block
.is also know as complete heart block -1
.there is P wave -2
PR interval is not constant nor progressive. The -3
first PR interval maybe narrow. The second very
wide & the third maybe just a bit longer than
0.20second. There is no association between the
.atrium & ventricles
.there maybe more P wave than QRS complex -4
Differentiation of 2nd & 3rd degree AV blocks
More P’s than QRS
2nd degree AV
block mobitz 2
PR fixed

3rd degree AV
block

QRS
regular

2nd degree AV
block mobitz1

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