Fist: degre AV block, Note the prolonged PR interval. (atrioventricular) block. PULL L Rate: Depends on rate of underlying rhythm Rhythm: Regular PWaves: Normal (upright and uniform) PR Interval: Prolonged (0.20 sec) QRS: Normal (0.06-0.10 sec) ¥ Clinical Tip: Usually AV block is benign, but if associated with an acute MI, it may lead to, further AV defectsFig. 1.19 First degree block and right —_—F0-3.18 First degree block bundle branch block Note + Sinus eth Note * PR intoval 380 ms *» Sinus rythm + T wave inversion in leads Il, VF suggests + PR interval 320 ms (first degree block) ‘schaemia + Broad QRS complexes + RSA! pattern best seen in Vp + Wide slurred $ in V5 Long PR interval and broad QRS complex with dominant R wave Intead V, {1 Long PR interval in ea i Fig. 9.24 First degree block and right bundle branch block .3.74 First degree block and right Note bundle branch block + Sinus rythm + PR interval 328 ms Ban + Right axis doviation fpinoe myer] 1 Breas OAS complexes +» PA interval 220 me (fst degree block) ‘+ RBBB pattern + RBBB Long PR interval — ‘and RBBB pattern Long PR interval and ESE) in teed Vv, BBB pattern in lead V, Fig. 3.81 First degree block and right bundle branch block Note © Sinus rhythm ‘= PR interval 240 ms + Right axis deviation * RBBB a) Long PR interval 1 and RBBB pattern SSIEH in lead V,Semen I ek 8 (A) Wenckebach block, with groaressive lengthening ofthe PR interval. (2) Mo1. First degree: The PR interval is groater than 0.2 seconds; all beats are conducted through to the ventricles, 2. Second degree: Only some baste are conducted through to the ventricles. a. Mobite type I (Wenckebach): Propressi prolongation of the PR interval until a QRS is dropped Tabseesceeeapeseseaney 2. Third degreat No baste are conducted through to the ventral ‘is complete heart black with AV dissociation, in which the ‘atria and ventricles are driven by independent pacemakers. “the Mobite type [block (Wenckebach phenomenon) Mobi type I block-a complication of an inferior myocardial infarction, “The PR interval i identical efore andl afer the Psrave that isnot conducted‘Type | (Mobitz | or Wenckebach) WPA intervals become progressively longer until one P wave is totally blocked and produces no ORS. Alter a pause, during which the AV node recovers, this cycle is repeated, Rate: Depends on rate of underlying rhythm Rhythm: Irregular P Waves: Normal (upright and uniform) IPR Interval: Progressively longer until one P wave is blocked and a ORS is dropped JQRS: Normal (0.06-0.10 sec) ¥ Clinical Tip: This rhythm may be caused by medication such as beta blockers, digoxir calcium channel blockers. Ischemia involving the right coronary artery is another cause. Type Il (Mobitz 1!) |i Conduction ratio (P waves to ORS complexes) is commonly 2:1, 3:1, or 4:1. | QRS complexes are usually wide because this block usually involves both bundle branches. and Rate: Atrial rate (usually 60-100 bpm); faster than ventricular rate Rhythm: Atrial regular and ventricular irregular PWaves: Normal (upright and uniform); more P waves than QRS complexes PR Interval: Normal or prolonged but constant JORS: Usually wide (>0.10 sec) ¥ Clinical Tip: Resulting bradycardia can compromise cardiac output and lead to complete AV ‘block. This rhythm often occurs with cardiac ischemia or an Ml.Fig. 3.19 Second degree block Fig, 3.20 Second degree block (2:1) (Wenckebach) Note ae + Sinus thythen chee * Alternate beats conducted and not +» PR interval lengthens progressively rom * Ateunate » Stay fms and inona P waveisot | ateralT wave inversion in leads I, VL, Vg + Small Q wave and laverted T wave in leads Suggests ischaemia ‘VF suggest an ol infer infarct P waves —_______ Fig. 3.29 secona degree block, lett Fig. 328 Second degree block and lent anterior hemiblock and right bundle anterior hemiblock branch block ‘Note Note «Sinus rhythm Sinus rythm '* Second degroe block (21 type) ‘= Second degree block (2:1 type) + Lett anterior hemiblock «+ Loft anterior hemiblock ‘+ Poor R wave progression suggests possible * REBB ‘ld anterior infarctFig. 379 Second dagros block (2:1) Note + Sinus tythm + Second degree block, 2:1 type + Ventcular rate 88min * Normal GAS complexes and T waves, P waves in lead V, ‘Third-degree AV block. The P waves appear at regular intervals, as do the QRS “Tied dgpee beat block pacemaker in dhe bundle of His produces a aasow ORS comple tp), whercas more dsl pacmaers tend w produce ‘ruler eomplenes tom Arrows sme PrasI Conduction between atria and ventricles is absent because of electrical block at or below the AV node. “Complete heart block” is another name for this rhythm. Rate: Atrial: 60-100 bpm; ventricular: 40-60 bpm if escape focus is junctional, <40 bpm if escape focus is ventricular Rhythm: Usually regular, but atria and ventricles act independently P Waves: Normal (upright and uniform); may be superimposed on ORS complexes orT waves PR Interval: Varies greatly QRS: Normal if ventricles are activated by junctional escape focus; wide if escape focus is ventricular Fig. 3.82 Complete block and Stokes-Adams. Fig. 3.80 Complete heart block = i - Note ‘+ Same patent as in Figure 3.81, Shue 701m + Suse om + Regular ventricular rate, 40/min + Ventricular rate 15tin + Noveionship between F waves and ORS. No elatonship belween P waves arc QRS complexes ‘complexes + Wide ORS complexes + No QRS complexes recorded in leads I + RBBB patie M, Vin, aves in lead VL P waves