Heart Block Report
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Transcript of Heart Block Report
Heart blockECG Hour
Olivia Faye J Listanco2nd Year IM Resident
Heart Blocks: Bundle branch
INTERRUPTION IN THE ELECTRICAL CONDUCTION SYSTEM OF EITHER THE RIGHT, LEFT OR BOTH BUNDLE BRANCHES.
CAUSES A DELAY TO THE VENTRICLES. THE INTERRUPTION FORCES THE
IMPULSE TO “DETOUR” AND TAKE ANOTHER ROUTE TO THE VENTRICLES.
Right Bundle Branch Block
RBB has ONE FASCICLE
When block occurs, the depolarization in the RBB is DELAYED
Right Bundle Branch Block
Right Bundle Branch BlockQRS complex
> 0.12 seconds
S wave Wide in lead I, wide and slurred in V5 to V6
rsR” V1 and V2Secondary ST-and-T-wave changes in V1 and V2
Left Bundle Branch Block
N septal depolarisation is reversed (RL),
Iimpulse spreads first to the RV via the right bundle branch and then to the LV via the septum
Right Bundle Branch Block CriteriaQRS complex
> 0.12 seconds
R wave Broad monophasic R wave in lead 1, V5, and V6No Q waves in V5 and V6
Left Ant Hemiblock
Left Ant HemiblockAxis LAD (-30 to -90)QRS <120 secR wave qR pattern in AvL
Time to peak R in aVL >45ms
Left Post Hemiblock
Left Post HemiblockAxis RAD (+90 - +180)QRS <120 secR wave qR pattern in lead I and
aVL with qR patterns in leads III ad avFTime to peak R in aVL >45ms
Heart conduction: AV Blocks
OCCUR WHEN THERE IS A PARTIAL OR COMPLETE INTERRUPTION IN THE CARDIAC ELECTRICAL CONDUCTION SYSTEM.
CAN OCCUR ANYWHERE IN THE ATRIA BETWEEN THE SA NODE AND THE AV JUNCTION.
IN THE VENTRICLES BETWEEN THE AV JUNCTION AND PURKINJE FIBERS.
THE APPEARANCE OF THE P WAVE AND QRS COMPLEX VARIES, DEPENDING ON THE TYPE OF HEART BLOCK.
RATE AND RHYTHM MAY VARY. LOCATION OF THE BLOCK AND PATIENT
SYMPTOMS DETERMINE IF THE DYSRHYTHMIA IS
LETHAL.
Normal Sinus RhythmRhythm RegularRate 60 – 100
P wave Normal in configuration; precede each QRS
PR Normal ( 0. 12 – 0.20 seconds )
QRS Normal ( less than 0.12 seconds )
First-degree AV blockRhythm RegularRate Usually normal
P wave Sinus P wave present; one P wave to each QRS
PR Prolonged (greater than 0.20 seconds )
QRS Normal
Second -degree AV block, Mobitz IRhythm IrregularRate Usually slow but can be
normalP wave Sinus P wave present; some
not followed by QRS complexes
PR Progressively lengthensQRS Normal
Second-degree AV block, Mobitz IIRhythm
Regular usually; can be irreguler if conduction ratios vary
Rate Usually slow
P wave Two, three, or four P waves before each QRS
PR PR interval of beat with QRS is constant; PR interval may be normal or prolonged
QRS Normal if block in His bundle, wide if block involves bundle branches
Third-degree AV blockRhythm RegularRate 40 – 60 if block in His bundle;
30 – 40 if block involves bundle branchesP wave Sinus P wave present; bear no
relationship to QRS; PR Varies greatlyQRS Normal if block in His bundle; wide if
block involves bundle branches
Mobitz I
Mobitz II atrioventricular block
Atrioventricular dissociation secondary to complete heart block
High-grade atrioventricular block
AF in RVR, RBBB, LAHB
Atrial flutter with LBBB
RBBB
LBBB
Thank you