HEART BLOCKS

FAILURE OF THE HEART’S NATURAL PACEMAKER DUE TO OBSTRUCTION

(“BLOCK”) IN THE ELECTRICAL CONDUCTION SYSTEM OF THE HEART.

Relationship of P waves to QRSs

All P waves are No P waves are

Some P waves are
followed by a followed by
not followed by QRSs
QRS but PR is >0.20 (associated with)
QRSs (i.e.,
AV dissociation)

First-Degree Progressive Every other PR interval of

AV block lengthening of P wave is not conducted P wave
PR until a conducted (2:1) is consistent
P is not
followed by
a QRS, then
repeated

QRS QRS is Only one More than QRS QRS is

< 0.12 0.12 or > P wave in one P wave < 0.12 0.12 or >
a row is not in a row
conducted is not
conducted

Second- Second- Second- Second- High Complete Complete

degree degree degree degree grade heart block heart block
AV block, AV block, AV block, AV block, AV block with with
Type I Type I Type II Type II junctional ventricular
escape escape
rhythm rhythm

1° 2° Type I 2° Type II 3°
Benign but Block at AV node, Block at Bundle of Ventricular
can progress usually transient, His, occurs with asystole in absence
does not usually anterior MI, often of escape beat
Significance
progress progresses to
complete block

Observation, Close monitoring, Atropine, Pacemaker,

d/c digitalis use d/c digitalis use, transcutaneous atropine, monitor
Treatment treat if patient or transvenous for hypoperfusion
is symptomatic pacemaker

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