First-degree AV block

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Questions and Answers

Which of the following best describes the underlying issue in atrioventricular (AV) block?

  • Irregular patterns in the depolarization of the ventricles.
  • Partial or complete interruption of impulse transmission from the atria to the ventricles. (correct)
  • Increased speed of impulse transmission from the atria to the ventricles.
  • Structural abnormalities within the chambers of the heart causing arrhythmia.

The most common cause of AV block is bacterial infection of the heart valves.

False (B)

Which of the following diagnostic tests is LEAST likely to be used in the initial evaluation of a patient with suspected AV block?

  • Echocardiogram.
  • Urine analysis. (correct)
  • Complete blood count (CBC).
  • Electrocardiogram (ECG).

What defines first-degree AV block on an ECG?

<p>Consistent PR interval greater than 0.20 seconds. (D)</p> Signup and view all the answers

In first-degree AV block, every P wave is followed by a QRS complex.

<p>True (A)</p> Signup and view all the answers

Which of the following is NOT a typical cause of first-degree AV block?

<p>Hyperthyroidism. (B)</p> Signup and view all the answers

First-degree AV block involves the consistent prolongation of the ______ interval.

<p>PR</p> Signup and view all the answers

A 25-year-old athlete is found to have a PR interval of 0.24 seconds on a routine ECG. He has no symptoms. What is the most likely explanation for this finding?

<p>Enhanced vagal tone. (B)</p> Signup and view all the answers

Which of the following ECG findings is characteristic of second-degree AV block type 1 (Mobitz I or Wenckebach)?

<p>Progressive prolongation of the PR interval followed by a dropped QRS complex. (A)</p> Signup and view all the answers

Second-degree AV block type 1 is always a pathological finding that requires immediate intervention.

<p>False (B)</p> Signup and view all the answers

Which of the following is NOT typically associated with causing second-degree AV block type 1?

<p>Advanced fibrosis of the conduction system. (A)</p> Signup and view all the answers

What is the typical management strategy for an asymptomatic patient with second-degree AV block type 1?

<p>Stopping or adjusting AV-blocking drugs</p> Signup and view all the answers

Which ECG characteristic defines second-degree AV block type 2 (Mobitz II)?

<p>Consistent PR interval with intermittently dropped QRS complexes. (C)</p> Signup and view all the answers

Second-degree AV block type 2 is generally considered a benign condition with a low risk of progressing to complete heart block.

<p>False (B)</p> Signup and view all the answers

Which of the following is a common cause of second-degree AV block type 2?

<p>Myocardial infarction. (A)</p> Signup and view all the answers

Patients with symptomatic second-degree AV block type 2 may require cardiac monitoring and temporary ______.

<p>pacing</p> Signup and view all the answers

A patient with known second-degree AV block type 2 presents with dizziness and fatigue. What is the MOST appropriate initial management strategy?

<p>Insertion of a temporary pacemaker. (D)</p> Signup and view all the answers

Which of the following best describes third-degree AV block (complete heart block)?

<p>Complete absence of electrical communication between the atria and ventricles. (D)</p> Signup and view all the answers

In third-degree AV block, the P waves and QRS complexes are synchronized and occur at a consistent rate.

<p>False (B)</p> Signup and view all the answers

Which of the following is a potential cause of third-degree AV block?

<p>Congenital heart disease. (A)</p> Signup and view all the answers

What is the typical initial treatment for a patient with symptomatic third-degree AV block?

<p>Urgent pacing</p> Signup and view all the answers

A patient with third-degree AV block is likely to present with which of the following symptoms?

<p>Severe bradycardia, syncope, and confusion. (B)</p> Signup and view all the answers

Match the AV block type with its corresponding ECG characteristic:

<p>First-degree AV block = Consistent PR interval &gt;0.20 seconds Second-degree AV block type 1 = Progressively lengthening PR interval with dropped QRS Second-degree AV block type 2 = Consistent PR interval with intermittent dropped QRS Third-degree AV block = P waves and QRS complexes not associated</p> Signup and view all the answers

Which AV block subtype is most likely to progress to complete heart block?

<p>Second-degree AV block type 2. (D)</p> Signup and view all the answers

The only long-term management option for third-degree AV block is medication.

<p>False (B)</p> Signup and view all the answers

Which of the following is NOT a recognized complication of advanced AV block?

<p>Increased exercise tolerance. (B)</p> Signup and view all the answers

A patient is diagnosed with first-degree AV block. Which of the following is the MOST important management step?

<p>Identifying and discontinuing any AV-blocking medications. (A)</p> Signup and view all the answers

What is the primary indication for pacemaker insertion in patients with AV block?

<p>Symptomatic bradycardia due to high-degree AV block. (B)</p> Signup and view all the answers

Enhanced vagal tone can be both a normal physiological response and a cause of AV block.

<p>True (A)</p> Signup and view all the answers

A patient with a history of Lyme disease presents with a prolonged PR interval on ECG. Which of the following is the MOST likely explanation?

<p>AV block secondary to Lyme carditis. (A)</p> Signup and view all the answers

Which electrolyte imbalance is MOST commonly associated with causing AV block?

<p>Hyperkalemia. (B)</p> Signup and view all the answers

Other than medications, what are two broad categories of conditions that can cause AV block?

<p>Infections, autoimmune</p> Signup and view all the answers

Second-degree AV block type 2 is characterized by a consistent ______ interval with intermittently dropped QRS complexes.

<p>PR</p> Signup and view all the answers

What does the term 'heart block' commonly refer to in clinical practice?

<p>Atrioventricular (AV) block. (B)</p> Signup and view all the answers

Which investigation will rule out structural heart disease?

<p>Echocardiogram (D)</p> Signup and view all the answers

Which of the following best describes the underlying issue in all types of atrioventricular (AV) block?

<p>Interruption of impulse transmission from atria to ventricles. (A)</p> Signup and view all the answers

First-degree AV block is always symptomatic and requires immediate intervention.

<p>False (B)</p> Signup and view all the answers

What is the defining ECG characteristic of first-degree AV block regarding the PR interval?

<p>prolonged PR interval (&gt;0.20 seconds)</p> Signup and view all the answers

In second-degree AV block type 1, there is a progressive prolongation of the ______ interval until a QRS complex is dropped.

<p>PR</p> Signup and view all the answers

Match the type of AV block with its corresponding ECG characteristic:

<p>First-degree AV block = Prolonged PR interval (&gt;0.20s), no dropped QRS Second-degree AV block (type 1) = Progressively lengthening PR interval, dropped QRS Second-degree AV block (type 2) = Consistent PR interval, dropped QRS Third-degree (complete) AV block = P waves and QRS complexes not associated, variable rhythm</p> Signup and view all the answers

A patient's ECG shows a consistent PR interval with intermittently dropped QRS complexes. Which type of AV block is most likely?

<p>Second-degree AV block (type 2) (B)</p> Signup and view all the answers

Second-degree AV block type 1 is typically managed with immediate pacemaker insertion.

<p>False (B)</p> Signup and view all the answers

List two potential causes of second-degree AV block type 2.

<p>MI, fibrosis</p> Signup and view all the answers

Third-degree AV block is characterized by a complete lack of electrical communication between the atria and the ______.

<p>ventricles</p> Signup and view all the answers

Which of the following ECG findings is most indicative of third-degree AV block?

<p>P waves and QRS complexes not associated. (B)</p> Signup and view all the answers

Patients with third-degree AV block always require a permanent pacemaker.

<p>True (A)</p> Signup and view all the answers

Name two symptoms that might be seen in a patient with second-degree AV block type 2 or third-degree AV block.

<p>syncope, chest pain</p> Signup and view all the answers

A common management strategy for all types of AV block involves stopping ______ drugs.

<p>AV blocking</p> Signup and view all the answers

Which complication is most likely to arise from untreated third-degree AV block?

<p>Sudden cardiac death (D)</p> Signup and view all the answers

An echocardiogram is useful in determining the specific subtype of AV block.

<p>False (B)</p> Signup and view all the answers

Which of the following is NOT typically a cause of first-degree AV block?

<p>Hyperthyroidism (C)</p> Signup and view all the answers

Athletes are less likely to experience first-degree AV block due to their lower vagal tone.

<p>False (B)</p> Signup and view all the answers

Name two AV blocking drugs.

<p>beta-blockers, digoxin</p> Signup and view all the answers

A PR interval greater than ______ seconds is considered prolonged.

<p>0.20</p> Signup and view all the answers

Which of the following differentiates second-degree AV block type 1 from type 2?

<p>PR interval behavior (D)</p> Signup and view all the answers

Second-degree AV block type 2 is generally considered benign and requires no specific intervention.

<p>False (B)</p> Signup and view all the answers

What electrolyte imbalance is listed as a potential cause of second-degree AV block type 2?

<p>hyperkalaemia</p> Signup and view all the answers

In third-degree AV block, the atria and ventricles beat ______ of each other.

<p>independently</p> Signup and view all the answers

Which of these conditions is least likely to cause third-degree AV block?

<p>Acute appendicitis (A)</p> Signup and view all the answers

First-degree AV block typically presents with symptoms like syncope and chest pain.

<p>False (B)</p> Signup and view all the answers

What type of monitoring is often required for patients with second-degree AV block type 2?

<p>cardiac monitoring</p> Signup and view all the answers

Fibrosis and ______ of the conduction system is a common cause of AV block.

<p>sclerosis</p> Signup and view all the answers

Which of the following is the MOST important initial step in managing a patient with symptomatic third-degree AV block?

<p>Immediate cardiac pacing (B)</p> Signup and view all the answers

A troponin level is useful in determining the type of AV block present.

<p>False (B)</p> Signup and view all the answers

Besides stopping AV-blocking medications, what other conservative measure can be considered for some patients with AV block?

<p>cardiac monitoring</p> Signup and view all the answers

The PR interval is measured from the beginning of the P wave to the beginning of the ______ complex.

<p>QRS</p> Signup and view all the answers

Which of the following is the MOST common cause of AV block overall?

<p>Idiopathic fibrosis and sclerosis (A)</p> Signup and view all the answers

All patients with first-degree AV block should be restricted from exercise.

<p>False (B)</p> Signup and view all the answers

What does 'FBC' stand for in the context of investigations for AV block?

<p>full blood count</p> Signup and view all the answers

In second-degree AV block type 2, the ______ interval remains consistent.

<p>pr</p> Signup and view all the answers

Flashcards

Atrioventricular (AV) block

Interruption of impulse transmission from atria to ventricles.

First-degree AV block

Consistent PR interval >0.20s; usually asymptomatic.

Second-degree AV block (type 1)

Progressive PR interval prolongation until a dropped QRS complex; usually benign.

Second-degree AV block (type 2)

Consistent PR interval with intermittently dropped QRS complexes; always pathological.

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Third-degree (complete) AV block

No electrical communication between atria and ventricles.

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ECG findings: First-degree AV block

PR interval >0.20s, no dropped QRS

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ECG findings: Second-degree type 1 AV block

Progressively lengthening PR interval, dropped QRS

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ECG findings: Second-degree type 2 AV block

Consistent PR interval, dropped QRS

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ECG findings: Third-degree AV block

P waves and QRS complexes not associated, variable rhythm

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First-degree AV block

Involves the consistent prolongation of the PR interval (>0.20 seconds) due to delayed conduction via the AV node.

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Causes of first-degree AV block

Enhanced vagal tone, post myocardial infarction and drugs.

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Rhythm in first-degree AV block

Regular

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P wave in first-degree AV block

Every P wave is present and followed by a QRS complex

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PR interval in first-degree AV block

Prolonged >0.2 seconds (5 small squares)

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QRS complex in first-degree AV block

Normal morphology and duration

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Symptoms of Second/Third-Degree AV Block

Symptoms may include palpitations, syncope, confusion, shortness of breath, or chest pain.

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Management of AV block

Stop AV blocking drugs; symptomatic cases may require pacing or pacemaker insertion; third-degree block often requires urgent pacing and a permanent pacemaker.

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Complications of AV block

Progression to complete block, sudden cardiac death, symptomatic bradycardia.

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Most common cause of AV block

Idiopathic fibrosis and sclerosis of the conduction system.

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Initial investigations for AV block

ECG, Labs (FBC, U&Es, TSH, troponin), Echo.

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Drugs causing first-degree AV block

AV blocking drugs such as beta-blockers, rate-limiting calcium-channel blockers, digoxin and magnesium.

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Aetiology of first-degree AV block

Enhanced vagal tone, Post myocardial infarction, Lyme disease. SLE, Congenital, Myocarditis, Electrolyte derangements, Drugs, Thyroid dysfunction.

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Study Notes

  • Atrioventricular (AV) block involves interruption of impulse transmission from atria to ventricles.
  • Identification is via characteristic ECG findings.
  • The most common cause of AV block is idiopathic fibrosis and sclerosis of the conduction system.
  • Investigation is required to identify underlying causes.
  • ECG helps to determine the subtype of AV block.
  • Laboratory investigations (e.g. FBC, U&Es, TSH, troponin) rules out underlying causes.
  • Echocardiogram rules out structural heart disease.

First-degree AV block

  • Consistent prolongation of the PR interval (defined as >0.20 seconds) is involved due to delayed conduction via the atrioventricular node.
  • Every P wave is followed by a QRS complex, with no dropped QRS complexes.
  • First-degree AV block is common and can often be an incidental finding.
  • Causes include enhanced vagal tone, often seen in athletes (non-pathological).
  • Other causes include post myocardial infarction, Lyme disease, systemic lupus erythematosus, congenital, myocarditis & electrolyte derangements.
  • Drugs, particularly AV blocking drugs such as beta-blockers, rate-limiting calcium-channel blockers, digoxin and magnesium are also causes.
  • Thyroid dysfunction may cause it.
  • It is usually asymptomatic.
  • Management includes stopping AV blocking drugs.

First-degree AV block ECG findings

  • Rhythm: regular.
  • P wave: every P wave is present and followed by a QRS complex.
  • PR interval: prolonged >0.2 seconds (5 small squares).
  • QRS complex: normal morphology and duration.

Second-degree AV block (type 1)

  • Progressive PR interval prolongation until a dropped QRS complex.
  • Causes include vagal tone, drugs, MI, myocarditis.
  • It is usually benign.
  • Management includes stopping AV blocking drugs.

Second-degree AV block (type 2)

  • Consistent PR interval with intermittently dropped QRS complexes.
  • Always pathological.
  • Causes include MI, fibrosis, cardiac surgery, inflammatory conditions, hyperkalaemia.
  • There is a risk of progression to complete AV block.
  • Management includes cardiac monitoring, temporary pacing, or pacemaker insertion.

Third-degree (complete) AV block

  • There is no electrical communication between atria and ventricles
  • Causes include congenital heart disease, fibrosis, ischaemic heart disease, infections, autoimmune conditions.
  • Management includes cardiac monitoring, pacing, or permanent pacemaker.

ECG findings

  • First-degree: PR interval >0.20s, no dropped QRS.
  • Second-degree type 1: progressively lengthening PR interval, dropped QRS.
  • Second-degree type 2: consistent PR interval, dropped QRS.
  • Third-degree: P waves and QRS complexes not associated, variable rhythm.

Symptoms

  • First-degree and second-degree type 1 are usually asymptomatic.
  • Second-degree type 2 and third-degree may present with palpitations, syncope, confusion, shortness of breath, chest pain.

Management

  • Stop AV blocking drugs.
  • Symptomatic cases may require pacing or pacemaker insertion.
  • Third-degree block often requires urgent pacing and a permanent pacemaker.

Complications

  • Progression to complete block.
  • Sudden cardiac death.
  • Symptomatic bradycardia.

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