Bradyarrhythmias

Dr.Shahab Ansari
 Objectives

• Brief Overview of Diagnosis

• Bradycardias and AV Blocks

• High Risk = High Payoff
 Definition

• Heart Rate < 60bpm

Ventricular Fibrillation
 Bradycardias

• Sinus Bradycardia
Arises from the SA Node HR <60
“Sinus” = Upright P wave in I II III avF Inverted in avR
• Junctional Rhythm
Arises from AV Node
Usually narrow rate is 40 - 60
• Ventricular or Escape Rhythm
Usual rate 20 – 40
Wide Complex Rhythm
Sinus Bradycardia
Junctional Bradycardia
Rate 40 - 60
Ventricular Escape Rhythm
Rate 20 - 40
AV Blocks
 First Degree AV Block

• 1 P wave for every QRS

• PR interval > 0.20 secs but
constant
• Significant only if bradycardic
First Degree AV Block
Second Degree Mobitz Type I {Wenkebach}

• P waves constant

• PR Intervals gradually increase until a dropped QRS complex

Second Degree Mobitz Type I {Wenkebach}
 Second Degree Mobitz Type II

• P waves are constant

• PR Intervals remain constant but dropped QRS Complexes

Second Degree Mobitz Type II
 Third Degree/ Complete Heart Block

• P waves constant
• QRS complexes are constant
• PR Intervals vary
No apparent association between P and QRS complexes
Third Degree/ Complete Heart Block
 Take Home Points
• Look at PR interval

• Not all bradycardia need treatment

My Rotation Is Over !!