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Dr. Agostini
8/24/2009 9:30am
Third degree AV block (complete AVB) atrial rate and ventricular rate are both constant but separate
• Rate
– Atrial: Unaffected
– Ventricular: < atrial rate
• AV nodal level block (40-60)
• Infranodal block (< 40)
• Rhythm
– Atrial: Usually regular
– Ventricular: Regular
• P waves: Normal
• PR: Will vary varying, random lengths
• QRS
– AV node or Bundle of His: narrow QRS
– Bundle branch level: Wide QRS
Sinus tachycardia is VERY common from exercise, medicine, acute injury, anxiety, etc.
Symptoms & Treatment ***Treat the underlying cause
• Pain: Analgesics
• Anxiety: Sedation
• Hemodynamic state: Beta blockers
• Hypovolemia: Volume replacement
• Myocardial damage: Hemodynamic monitoring and drug therapy
Sinus bradycardia
• Rate: < 60
• Rhythm: Regular
• P waves: Upright in 1, 2, aVF
Treatment
• If symptomatic, treat with atropine
• May need pacemaker
Atropine
Epinephrine
Fluid replacement
Pacemaker
Adenosine
A 60 year old female presents complaining of heart palpitations and becomes unstable. Based on the following
EKG, which treatment would you administer?
Vagal stimulation
Adenosine
Diltiazem
Beta-blockers
Cardioversion
A 74 year old male presents to the ED and is unresponsive. An EKG was administered and showed a rhythm
but a pulse is unable to be palpated anywhere. You decide that the patient has pulseless electrical activity and
you are unable to identify a reversible cause. What would be your next course of treatment?
Epinephrine
Dilitazem
Vagal stimulation
Cardioversion
Defibrillation