HEART BLOCK
OR
ATRIO VENTRICULAR BLOCK
[Link] .[Link],
Nursing Tutor,
Government College of
Nursing,Siddhpur
Definition
It occur when the conduction of impulses through the
AV nodal area is decreased or stopped.
Etiology
Medications e.g. Digitalis, calcium channel blocker,
beta blockers
Myocardial ischemia
Myocardial infraction
Increased vagal tone e.g. suctioning, pressure over
eye.
Classification
First Degree Heart Block
It occurs when all the atrial impulses are conducted
through the AV node into the ventricle at a rate slower
than the normal.
ECG Characteristics
Ventricular and artrial rate
QRS Complex: Normal
PR Interval more than 0.20 sec.
P wave : Normal
Cont
Second Degree Heart Block
It occurs when all but one of the atrial impulses are
conducted through the AV node into the ventricle.
Each impulse takes a longer time than the previous
impulse
ECG characteristics
Ventricular and atrial rate
Rhythm:RR interval gradually shorten
QRS Complex: normal/abnormal
PR interval: longer with every ECG
P wave: Normal
P:QRS-3:2,4:3,5:4.
Cont.
Treatment
[Link] is administered to increase heart rate
Temporary pacemaker may be used
If patients is asymptomatic monitor the rhythm
slowly.
Third Degree Heart Block
It occurs when no atrial impulse is conducted through
the AV node into the ventricles. Here 2 impulses
stimulate heart, one stimulate the ventricle and other
the atria.
ECG characteristics
Ventricular and atrial rate
Rhythm:PP and RR interval are regular but not equal
PR interval :irregular
P:QRS-P waves are more than QRS complexes.
Clinical Manifestation
Activity Intolerance
Weakness
Hypotension
Dizziness
Shortness of Breath
Dyspnea
Palpitation
Altered mental status
Anxiety
Respiratory Insufficiency
Syncope
Seizures
Pallor
Decreased urine output
Diagnostic Evaluation
History Collection
Physical Examination
12 lead ECG
Serum Electrolyte level
Exercise stress testing
Holter monitoring
Atrial Electrogram (It is similar to an ECG but is used
to monitor atrial rhythm)
Management
Medical Management
Defibrillation and Cardioversion
CPR
Automatic External Defrillator
Cardiac Pacing
Antirhythmic Drugs
Class-1 Sodium channel blocker e.g. disopramide
Class-2 Beta adrenergic blocker e.g. Metoprolol
Class-3 Potassium channel Blocker e.g. Verapamil
Oxygen Administration
Implantable cardioverter defibrillator
Anti coagulation
Reduce intake of caffeine, low fat and cholesterol
Surgical Management
Left Ventricular Infarctectomy
Myocardial Revascularization
Encircling Ventriculotomy
Nursing Management
Monitor the pt heart rhythm Properly
Monitor CO
Document dysrhythmias in ECG
Monitor the patients lab value
Administer anti dysrhythmias agents
Administer Oxygen
Minimize the anxiety
DYSARRHYTHMIAS
It is the disorder of the formation or conduction of
electrical impulses within the heart altering the heart
rate ,rhythm or both potentially causing altered blood
flow.
Etiology
Cardiac Condition Other Condition
Acid Base Imbalance
Alcohol
Caffeine and tobacco intake
Cardiomyopathy
Connective tissue disorder
Heart Failure Drugs toxicity
Electric shock
Myocardial cell degeneration
Electrolyte Imbalance
Myocardial infarction Hypoxia
Shock
Valve Disease
Metabolic Disorders
Poisoning
Pathophysiology
Cardiac cycle depends on a balance of basic regulatory
substance (Na,K,Ca and catecholamine)
Imbalance in the regulator can cause disturb pacing
function, conduction or myocardial contractility
Dysarrythmias
Classification
They are classified as the following;
Sinus node
Atrial node
Normal Junctional
Ventricular dysarrhythmias
Sinus Node Arrhythmias
Sinus Bradycardia
It occures when the sinus node creates an impulse at a
slower than normal rate
Causes
Low metabolic demand
Vagal Stimulation
Increased ICP
Myocardial infarction
Cont
ECG Characteristics
Ventricular and atrial rate less than 60.
Rhythm: Normal
P wave: Normal and Consistent
P:QRS ratio-1:1
Treatment
[Link] 0.5-1.0 mg/iv
IV catecholamine
Transcutaneous Pacing
Cont
Sinus Tachycardia
It occures when the sinus node creates an impulse at a
faster than normal rate.
Causes
Acute blood loss
CCF
Pain
Hyper metabolic State
Fever
Anxiety
Cont
ECG Characteristics
Ventricular and Atrial rate more than 100.
Rhythm: Normal
P Wave: Normal and consistent
P:QRS ratio-1:1
Cont.
Sinus Arrhythmias
It occures when the sinus node create an impulse at a
irregular rhythm, rate usually increases with
inspiration and decrease with expiration
ECG Characteristics
Ventricular and atrial rate :60-100
Rhythm Irregular
QRS Wave Abnormal
P Wave; Normal
P:QRS ratio-1:1
Atrial Dysarrythmias
1. Pre Mature Atrial Complex
It occurs when an electrical impulse starts in the
atrium before the normal impulse of the sinus node.
Causes
Intake of Caffeine
Alcohol
Nicotine
Anxiety
Infarction
Note: Treatment is not usually required
Cont.
[Link] flutter
It occur when the atrium creates an impulse at a rate of
250-400/min. Atrial rate is faster than AV node can
conduct not all atrial impulse enter ventricle causing a
therapeutic AV block.
Causes
Hypotension
Cardiomyopathy
Heavy alcoholism
Open Heart surgery
Management
Cardio version
Ad.B-blocker and
Digitalis
Cont
[Link] Fibrillation
It causes a rapid,disorganised and uncontrolled
twitching of the atrial musculature.
Causes
Same as Atrial Flutter
Treatment
Cardio version
Medication: Amiodarone
Calcium Channel Blockers
Warfarin
Digoxin to improve cardiac function
Pacemaker
Junctional Dysarrythmias
[Link] Junctional Complexes
It is an impulse that starts in the AV nodal area before
the next normal sinus impulse reaches AV node.
[Link] Rhythm
It occurs when the AV node instead of the SA node
becomes the pacemaker of the Heart
Treatment: Emergency Pacing
[Link] Nodal reentry tachycardia
It occurs when an impulse is conducted to an area in
the AV node that causes the impulse to be re routed
back into the same area over and over again at a faster
rate.
Ventricular Dysarrhythmias
Premature Ventricular Complex
It is an impulse that start in the ventricle and is
conducted through the ventricle before the next normal
sinus impulse
Ventricular Tachycardia
It is defined as more than 3 PVC in a row. It is treated
with immediate defibrillation
Ventricular Fibrillation
It is rapid but disorganized ventricular rhythm that
causes ineffective waves from ventricle. No atrial
activity seen in ECG.
Cont
Treatment
CPR and emergency services
Transcutaneous pacing
