Third degree AV block: Difference between revisions
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==Background== | ==Background== | ||
*Also known as complete heart block | |||
*No conduction through the AV node, causing the atria and ventricles beat completely independently from each other | |||
*The ventricular beat is an escape rhythm anywhere from the AV node to the bundle-branches (normally slow, varying from 35 to 45 beats per minute) | |||
===Causes=== | ===Causes=== | ||
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==Clinical Features== | ==Clinical Features== | ||
*Dizziness | *[[Dizziness]] | ||
*[[Syncope]] | *[[Syncope]] | ||
*Hypotension | *[[Hypotension]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Management== | ==Management== | ||
*[[ | *Standard [[ACLS guidelines for bradycardia]] to include<ref name="Sovari">Sovari AA et al. Second-Degree Atrioventricular Block Treatment & Management. eMedicine. Apr 28, 2014. http://emedicine.medscape.com/article/161919-treatment#showall.</ref> | ||
**[[Atropine]] 0.5mg IV q3-5min prn | |||
**[[Transcutaneous pacing]], followed by [[transvenous pacing]] | |||
*Treat underlying etiology | |||
*Avoid AV nodal blocking agents (e.g. [[beta blockers]]) | |||
==Disposition== | ==Disposition== | ||
*Admission | *Admission for [[Pacemaker (Basics)|pacemaker]] placement | ||
==See Also== | ==See Also== | ||
Revision as of 10:35, 3 November 2016
Background
- Also known as complete heart block
- No conduction through the AV node, causing the atria and ventricles beat completely independently from each other
- The ventricular beat is an escape rhythm anywhere from the AV node to the bundle-branches (normally slow, varying from 35 to 45 beats per minute)
Causes
- Congenital
- Acquired
- Ischemia
- Drugs
- Structural heart disease
Clinical Features
Differential Diagnosis
AV blocks
- First degree AV block
- Second degree
- Third degree AV block
- AV dissociation without complete heart block
Evaluation
- No atrial impulses are conducted
- P waves normal and regular P-P intervals unrelated to slower regular R-R intervals
- QRS narrow if block above bundle of His
- QRS wide if block below bundle of His
- PR variable
Management
- Standard ACLS guidelines for bradycardia to include[1]
- Atropine 0.5mg IV q3-5min prn
- Transcutaneous pacing, followed by transvenous pacing
- Treat underlying etiology
- Avoid AV nodal blocking agents (e.g. beta blockers)
Disposition
- Admission for pacemaker placement
See Also
References
- ↑ Sovari AA et al. Second-Degree Atrioventricular Block Treatment & Management. eMedicine. Apr 28, 2014. http://emedicine.medscape.com/article/161919-treatment#showall.