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Heart block

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Major types of heart block

Publicado en: Salud y medicina
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Heart block

  1. 1.  Introduction .  Definition Of Atrio-ventricular Heart Block .  Etiology .  Types of Heart Block :  First degree heart block .  Second degree heart block.  Third Degree ( Complete ) heart block .  Clinical Manifestation .  Management .  Nursing Diagnosis.
  2. 2.  Cardiac Conduction system and Normal ECG:
  3. 3.  It is a partial or complete interruption of impulses transmission from Atrium to Ventricle .
  4. 4.  Acute myocardial Infarction: specially Inferior MI .  Medications : Beta Blockers , calcium channel blockers or Digoxin .  Inflammation : myocarditis , Rheumatic fever or Lupus .  Infections :Toxoplasmosis . Causes of permanent block  Acute myocardial infarction : specially Anterior MI .  Degeneration of Conduction system due to : advanced age or cardiac calcification of mitral or aortic valve .  Latrogenic damage : due to arrhythmia Ablation at the site of AV Junction or Valve surgery (Tricuspid valve replacement) .
  5. 5.  According to relation between Atrium andVentricle , we can detect three degrees of AV heart block : ▪ First Degree Heart Block : slowing of Conduction . ▪ Second Degree Heart Block : intermittent interruption of conduction subtype into : ▪ Mobitz Type I . ▪ Mobitz Type II . ▪ Third Degree ( Complete ) Heart Block : Complete interruption of conduction .
  6. 6.  It is not consider complete block ,it is just slow down of impulses that come from SA node more than the normal .
  7. 7.  ECG Manifestation :  Prolongation of PR interval more than 0.2 second or more than 5 small squares .  Constant PR interval from beat to another .  Regular Rhythm .  Normal Rate or slightly slow .
  8. 8.  This problem occur at the level of AV node itself .  It also is not considered a complete block .
  9. 9.  ECG Manifestations :  It is characterized by progressive prolongation of PR interval until dropped QRS , then the cycle start again .  Constant PP interval .  Irregular Rhythm .  Normal or slightly slow Rate .
  10. 10.  This type of block occur below AV node at the level of Hiss Bundle.  Also is considered incomplete but high risk to be complete.  Some of electrical impulses are unable to reach ventricles .
  11. 11.  ECG Manifestation :  Recurrent appearance of non-conducted P waves which is blocked and not followed by QRS complex ( indicate to block of impulses to reach ventricle ) .  PR interval and PP interval are constant .  QRS usually normal but sometimes become Wide .
  12. 12.  Characterized by Atrio-ventricular dissociation .  This blockage level is infra-nodal ( Bilateral Bundle Branches ) .  Atrial and ventricular activities are unrelated due to complete block of electrical impulses to reach the ventricle.  Another pacemaker distal to the block takes over in order to activate the ventricles or ventricular standstill will occur.
  13. 13.  ECG manifestation :  Dissociation between P wave and QRS  P wave may overlap on T wave or QRS complex .  PR interval is not constant  Rate usually less than 40 .  QRS complex usually wide and sometimes normal .
  14. 14.  Usually first degree and sometimes second degree are asymptomatic .  The most common signs and symptoms :  Sever Bradycardia .  Hypotension .  Syncope ( fainting ) .  Chest pain .  Dyspnea .  Dizziness .
  15. 15.  General Management :  Cardiac monitoring : for close observation .  Oxygen supply : to Manage de-saturated patients .  IV Line :To support blood pressure with fluids .  Atropine standby : to treat bradycardia specially incomplete degrees .
  16. 16. Management of heart block depend on symptoms  First degree heart block : this type usually is asymptomatic and not indicated for treatment :  Close observation of Hemodynamic status .  Discontinue of some medication that cause bradycardia such as : ▪ Beta-blockers : Concor ▪ Digoxins : Lanoxine ▪ calcium channel blockers : Diltiazem . Just for
  17. 17.  Second Degree and Complete heart block :  Usually these degrees are associated with sever bradycardia which can be treated by atropine .  Associated conditions should be treated correctly such as : ▪ Myocardial infarction. ▪ Electrolyte disturbance (hyperkalemia). ▪ Digitals intoxication.  Transvenous temporary pacemaker is indicated for pt with sever bradycardia who has no effect of Atropine administration (For 24 hours : 48 hours .)  Transcutanous permanent pace-maker is indicated for chronic AV block .
  18. 18.  Nursing priorities :  Decrease cardiac output related to failure of the heart to pump enough blood to meet metabolic needs of the body as manifested by hypotension .  Acute chest Pain related to decrease blood flow to myocardium through coronary arteries .  Ineffective Tissue perfusion related to decrease cardiac output as manifested by pt syncope .  Fatigue related to increase hypoxic tissue and slowed removal of metabolic wastes.

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