ECG OF THIS WEEKECG OF THIS WEEKDr.A.MeenakshiDr.A.Meenakshi..

PROF.S.TITO’S UNIT. M6 PROF.S.TITO’S UNIT. M6

Sinus rhythm.Sinus rhythm.Rate 45 per minute.Rate 45 per minute.Axis +30 degree. Axis +30 degree. PR interval 180msec.PR interval 180msec.PR interval constant.PR interval constant.QRS duration 80 msec.QRS duration 80 msec.QTc490msec.QTc490msec.2:1 block2:1 blockConstant PP interval.Constant PP interval.ST-T changes in LeadI,avL,V1,V2.ST-T changes in LeadI,avL,V1,V2.DIAGNOSIS-MOBITZ TYPE II HEART BLOCK with 2:1 DIAGNOSIS-MOBITZ TYPE II HEART BLOCK with 2:1

BLOCK.BLOCK.

Heart blockHeart block

Heart block is a delay or interruption in Heart block is a delay or interruption in conduction of atrial impulse through the conduction of atrial impulse through the AV conducting system.AV conducting system.

FIRST DEGREE AV block;FIRST DEGREE AV block; Delay in conduction through the Delay in conduction through the

conducting system.conducting system. Leading to prolonged PR interval >0.20 Leading to prolonged PR interval >0.20

sec.sec. All P waves are followed by QRS All P waves are followed by QRS

complexes.complexes.

SECOND DEGREE AV BLOCK;SECOND DEGREE AV BLOCK; Intermittent failure or interruption of Intermittent failure or interruption of

AV conduction.AV conduction. Two types;-Mobitz typeI ,Mobitz typeII.Two types;-Mobitz typeI ,Mobitz typeII. Mobitz typeI or Wenckebach Mobitz typeI or Wenckebach

phenomena;phenomena; Progressive prolongation of PR interval Progressive prolongation of PR interval

until a beat is dropped.until a beat is dropped.

Mobitz type II AV blockMobitz type II AV block Sudden block of conduction of an impulse Sudden block of conduction of an impulse

occurs.occurs. PR interval of all impulse is constant prior PR interval of all impulse is constant prior

to blocked P wave. to blocked P wave. Lesion usually occurs in the bundle of HIS.Lesion usually occurs in the bundle of HIS. It can be due to Rheumatic It can be due to Rheumatic

carditis,coronary artery disease.carditis,coronary artery disease. Always organic or pathological.Always organic or pathological. Prognosis bad.Prognosis bad.

THIRD DEGREE(COMPLETE AV THIRD DEGREE(COMPLETE AV BLOCK);BLOCK);

Complete interruption of AV Complete interruption of AV conduction occurs.conduction occurs.

P wave has no relationship to QRS P wave has no relationship to QRS complex.complex.

Treatment of second degree heart Treatment of second degree heart block;-block;-

Asymptomatic is treated by vagolytic Asymptomatic is treated by vagolytic agent atropine.agent atropine.

Indication for permanent pacing;-Indication for permanent pacing;- 1 .Symptomatic second degree AV block1 .Symptomatic second degree AV block 2.AV block in acute anterior MI.2.AV block in acute anterior MI. 3.Asymptomatic advanced second 3.Asymptomatic advanced second

degree AV block with asystole greater degree AV block with asystole greater than 3 seconds.than 3 seconds.