kamlya balgoon 2009 av blocks av block occur when the conduction of impulse through av node...

Kamlya balgoon2009

AV BlocksAV block occur when the conduction of

impulse through AV node decrease or stop Prolonged P-R interval or more P waves

than QRSBlock means DELAY.

Causes Medication heart & valvular disease

kemo 2009

1 -1st Degree AV BlockIt artial impulse conduct through AV node

into ventricle are rate slower than normal It looks like the sinus rhythm but with

prolonged P-R interval..Normal and identical P waves. Each P is Followed by a QRSNormal QRS.P-R interval is 0.20 sec or moreP: QRS ratio : 1 :1

Prolonged P-R intervalkemo 2009

2 -2nd Degree AV Block a- Mobitz I Normal QRS. Identical P waves. P-R interval progressively prolongs

until there is P not followed by a QRS

P without QRS

kemo 2009

2 -2nd Degree AV Block a- Mobitz II

Identical P waves, Not every P is followed by a QRS.

When there is a QRS, it has to be preceded by a P wave

Atrial rate is regular.Check BP immediately.

Every QRS preceded by a P waves

Identical P waves

kemo 2009

4- 3rd Degree AV Block( Complete Heart Block )

No relationship between P waves and QRS complexesCheck the BP immediately

kemo 2009

ECG: changes in heart rate, rhythm.*Blood chemistry: electrolyte imbalance.Nursing intervention:Monitor pulse for irregular pattern or abnormally rapid or slow rate.Observe for arrhythmiascontinuous cardiac monitoring.Assess cardiovascular, respiratory, and neurovascular status.

Possible diagnostic findings

kemo 2009

Initiate cardiopulmonary resuscitation (CPR), if indicated, until other advanced cardiac life support

measures are available and successful.

Perform defibrillation early for ventricular tachycardia and ventricular fibrillation.

kemo 2009

Nursing intervention

Nursing interventionAdminister medications, oxygen, and I.V

fluids, as needed.Prepare for procedures, such as

cardioversion Monitor for predisposing factors (such as

fluid and electrolyte imbalance) and signs of drug

toxicity, especially digoxin. Monitor and record vital signs.Maintain prescribed diet.Maintain bed rest, until patient is stable.Provide support to the patient and family. kemo 2009

Sinus Rhythm ( the only normal one )

Heart rate rhythmP waveP r interval In second

QRS in second

Rate 60-100 b/pm

RegularNormal identical P waves

0 ,12 to 0,20 seconds

second 0,12

Sinus arrhythmia or sinus block

Heart rate rhythmP waveP r interval In second

QRS in second

Rate 60-100 b/pm

irregular rhythm

Normal identical P waves

0,12 to o,20 second

o,20 second Normal

A total beat missed

Premature A trial Complex ( PAC)

Heart rate rhythmP waveP r interval In second

QRS in second

depend on underlying rhythm

irregular rhythm

different p wave , hidden in T wave

0 ,12 to 0,20 second

Normal, ubnormal 0,12

Premature Ventricular Contraction ( PVC )

Heart Rate rhythmP waveP r interval In second

QRS in second

depend on rhythm

irregular visibility p wave depend time of PVC may absent or in front QRS

less than 0,12 second

duration 0.12 second or more . Bizarre , abnormal shape

PVCs (early,

wide and bizarre)

Premature Ventricular Contraction ( PVC )

Heart Rate rhythmP waveP r interval In second

QRS in second

depend on rhythm

irregular visibility p wave depend time of PVC may absent or in front QRS

less than 0,12 second

duration 0.12 second or more . Bizarre , abnormal shape

Multifocal ( different shape )

Premature Ventricular Contraction ( PVC )

Heart Rate rhythmP waveP r interval In second

QRS in second

depend on rhythm

irregular visibility p wave depend time of PVC may absent or in front QRS

less than 0,12

second

duration 0.12

second or more .

Bizarre , abnormal

shape

Unifocal

Premature Ventricular Contraction ( PVC )

Heart Rate rhythmP waveP r interval In second

QRS in second

depend on rhythm

irregular visibility p wave depend time of PVC may absent or in front QRS

less than 0,12 second

duration 0.12 second or more . Bizarre , abnormal shape

Couplets

Premature Ventricular Contraction ( PVC )

Bigeminy :-every other beat is PVC

Heart Rate rhythmP waveP r interval In second

QRS in second

depend on rhythm

irregular visibility p wave depend time of PVC may absent or in front QRS

less than 0,12 second

duration 0.12 second or more . Bizarre , abnormal shape

Premature Ventricular Contraction ( PVC )Trigeminy :- every third complex is PVC

Heart Rate rhythmP waveP r interval In second

QRS in second

depend on rhythm

irregular visibility p wave depend time of PVC may absent or in front QRS

less than 0,12 second

duration 0.12 second or more . Bizarre , abnormal shape

(Asystole (

kemo 2009

Heart Rate rhythmP wavePR interval In second

QRS in second

No heart rate

irregularNo P wave NoNo QRS.

1 -1st Degree AV BlockAV block occur when the conduction of impulse

through AV node decrease or stop Prolonged P-R interval

kemo 2009

Heart Rate rhythmP wavePR interval In second

QRS in second

Depend on rhythm

Depend on rhythm

sinus rhythm , regular shape

P-R interval is 0.20 sec or more

Normal QRS.

2 -2nd Degree AV Block a- Mobitz IP without QRS

kemo 2009

Heart Rate

rhythmP wavePR interval In second

QRS in second

Depend on rhythm

sinus rhythm but with prolonged P-R interval

Shape depend on rhythm

P-R interval progressively prolongs until there is P not followed by a QRS

Normal QRS.

2 -2nd Degree AV Block a- Mobitz II

Every QRS preceded by a P waves

Identical P waves

kemo 2009

Heart Rate rhythmP wavePR interval In second

QRS in second

Depend on rhythm

irregularIShape depend on rhythm

P-R interval is 0.20 sec or more

a QRS, it has to be preceded by a P wave .

3rd Degree AV Block( Complete Heart Block )

Heart Rate rhythmP wavePR interval In second

QRS in second

Depend on escape & artial rhythm

sinus rhythm , irregular

Depend on rhythm

Very irregular

More p wave than QRS.

kemo 2009