Tx: repair/replace pacemaker
Sunday, September 25, 2016
1st degree AV block
Tx:
Figure out H's & T's
Be prepared to use external pacer
Mechanism:
First-degree atrioventricular (AV) block, or first-degree heart block, is defined as prolongation of the PR interval on an electrocardiogram (ECG) to more than 200 msec.[1] The PR interval of the surface ECG is measured from the onset of atrial depolarization (P wave) to the beginning of ventricular depolarization (QRS complex). Normally, this interval should be between 120 and 200 msec in the adult population. First-degree AV block is considered “marked” when the PR interval exceeds 300 msec.[2]
Whereas conduction is slowed, there are no missed beats. In first-degree AV block, every atrial impulse is transmitted to the ventricles, resulting in a regular ventricular rate.
See more/Sources:
http://emedicine.medscape.com/article/161829-overview
sinus tachycardia
Rate: 13 QRS x 10 = 130 (assumed this is a 6-sec strip) or see 2 boxes between 2 QRS = about 150 bpm
Rhythm:
P - P before each QRS
QRS - QRS is after each Q
Regularity - Every beat is overall the same
Axis - skip this for now
Width:
PR interval - 3ss (normal) and is fixed in every beat
Q - 1ss (<0.11sec) - normal
RR: QT segment < 1/2 RR
Height:
P wave upright in lead II (assumed lead II for every 6sec strip)
No ST elevation
=> This is a normal sinus tachycardia NSR tachy!
2nd degree AV block with Mobitz II
Tx:
watchful waiting,
figure out causes,
pacemaker,
atropine can be tried if rhythm isn’t due to ischemia (i.e. MI). Atropine, when the heart is ischemic, can cause ventricular tachycardia!
A-fib
Tx:
- Anticoagulation,
- synchronized cardioversion (if appropriate),
- beta blockers to control heart rate
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