Second degree AV block type II
Revision as of 04:29, 25 July 2016 by Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==")
Background
- Significant risk of hemodynamic instability, symptomatic bradycardia, and decompensation into Third Degree AV Block
- Risk of asystole 35% per year[1]
Clinical Features
- Bradycardia
- Altered mental status
- Syncope, weakness
Differential Diagnosis[2][3]
- Anterior MI
- Rheumatic fever
- Myocarditis
- Lyme disease
- Lenegre's disease
- Lev's disease
- SLE
- Systemic sclerosis
- Amyloidosis
- Hemachromatosis
- Sarcoidosis
- Hyperkalemia
- Toxicology
AV blocks
- First degree AV block
- Second degree
- Third degree AV block
- AV dissociation without complete heart block
Evaluation
- ECG findings
- Fixed PR interval for conducted QRS complexes
- Intermittent non-conducted P-waves
- P waves march through (beware of p-waves consistently buried in T-waves)
Management
- Standard ACLS guidelines for bradycardia to include[4]
- Atropine 0.5mg IV q3-5min prn
- Transcutaneous pacing, followed by transvenous pacing
- Treat underlying etiology
- Avoid AV nodal blocking agents (beta blockade in myocardial infarction)
Disposition
- Admission for pacing and monitoring
- Subsequent permanent pacemaker
- 2:1[4] and 3:1 blocks
- May be unable to determine if Second Degree AV Block Type I or type II
- Admit to cardiology and assume type II
See Also
AV blocks
- First degree AV block
- Second degree
- Third degree AV block
- AV dissociation without complete heart block
References
- ↑ Burns E. AV Block: 2nd degree, Mobitz II. Life in the Fast Lane. http://lifeinthefastlane.com/ecg-library/basics/mobitz-2/.
- ↑ Hampton, JR. The ECG in Practice (5th edition), Churchill Livingstone 2008.
- ↑ Wagner, GS. Marriott’s Practical Electrocardiography (11th edition), Lippincott Williams & Wilkins 2007.
- ↑ 4.0 4.1 Sovari AA et al. Second-Degree Atrioventricular Block Treatment & Management. eMedicine. Apr 28, 2014. http://emedicine.medscape.com/article/161919-treatment#showall.