Podcast
Questions and Answers
Which of the following best describes the underlying issue in atrioventricular (AV) block?
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.
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?
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?
What defines first-degree AV block on an ECG?
In first-degree AV block, every P wave is followed by a QRS complex.
In first-degree AV block, every P wave is followed by a QRS complex.
Which of the following is NOT a typical cause of first-degree AV block?
Which of the following is NOT a typical cause of first-degree AV block?
First-degree AV block involves the consistent prolongation of the ______ interval.
First-degree AV block involves the consistent prolongation of the ______ interval.
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?
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?
Which of the following ECG findings is characteristic of second-degree AV block type 1 (Mobitz I or Wenckebach)?
Which of the following ECG findings is characteristic of second-degree AV block type 1 (Mobitz I or Wenckebach)?
Second-degree AV block type 1 is always a pathological finding that requires immediate intervention.
Second-degree AV block type 1 is always a pathological finding that requires immediate intervention.
Which of the following is NOT typically associated with causing second-degree AV block type 1?
Which of the following is NOT typically associated with causing second-degree AV block type 1?
What is the typical management strategy for an asymptomatic patient with second-degree AV block type 1?
What is the typical management strategy for an asymptomatic patient with second-degree AV block type 1?
Which ECG characteristic defines second-degree AV block type 2 (Mobitz II)?
Which ECG characteristic defines second-degree AV block type 2 (Mobitz II)?
Second-degree AV block type 2 is generally considered a benign condition with a low risk of progressing to complete heart block.
Second-degree AV block type 2 is generally considered a benign condition with a low risk of progressing to complete heart block.
Which of the following is a common cause of second-degree AV block type 2?
Which of the following is a common cause of second-degree AV block type 2?
Patients with symptomatic second-degree AV block type 2 may require cardiac monitoring and temporary ______.
Patients with symptomatic second-degree AV block type 2 may require cardiac monitoring and temporary ______.
A patient with known second-degree AV block type 2 presents with dizziness and fatigue. What is the MOST appropriate initial management strategy?
A patient with known second-degree AV block type 2 presents with dizziness and fatigue. What is the MOST appropriate initial management strategy?
Which of the following best describes third-degree AV block (complete heart block)?
Which of the following best describes third-degree AV block (complete heart block)?
In third-degree AV block, the P waves and QRS complexes are synchronized and occur at a consistent rate.
In third-degree AV block, the P waves and QRS complexes are synchronized and occur at a consistent rate.
Which of the following is a potential cause of third-degree AV block?
Which of the following is a potential cause of third-degree AV block?
What is the typical initial treatment for a patient with symptomatic third-degree AV block?
What is the typical initial treatment for a patient with symptomatic third-degree AV block?
A patient with third-degree AV block is likely to present with which of the following symptoms?
A patient with third-degree AV block is likely to present with which of the following symptoms?
Match the AV block type with its corresponding ECG characteristic:
Match the AV block type with its corresponding ECG characteristic:
Which AV block subtype is most likely to progress to complete heart block?
Which AV block subtype is most likely to progress to complete heart block?
The only long-term management option for third-degree AV block is medication.
The only long-term management option for third-degree AV block is medication.
Which of the following is NOT a recognized complication of advanced AV block?
Which of the following is NOT a recognized complication of advanced AV block?
A patient is diagnosed with first-degree AV block. Which of the following is the MOST important management step?
A patient is diagnosed with first-degree AV block. Which of the following is the MOST important management step?
What is the primary indication for pacemaker insertion in patients with AV block?
What is the primary indication for pacemaker insertion in patients with AV block?
Enhanced vagal tone can be both a normal physiological response and a cause of AV block.
Enhanced vagal tone can be both a normal physiological response and a cause of AV block.
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?
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?
Which electrolyte imbalance is MOST commonly associated with causing AV block?
Which electrolyte imbalance is MOST commonly associated with causing AV block?
Other than medications, what are two broad categories of conditions that can cause AV block?
Other than medications, what are two broad categories of conditions that can cause AV block?
Second-degree AV block type 2 is characterized by a consistent ______ interval with intermittently dropped QRS complexes.
Second-degree AV block type 2 is characterized by a consistent ______ interval with intermittently dropped QRS complexes.
What does the term 'heart block' commonly refer to in clinical practice?
What does the term 'heart block' commonly refer to in clinical practice?
Which investigation will rule out structural heart disease?
Which investigation will rule out structural heart disease?
Which of the following best describes the underlying issue in all types of atrioventricular (AV) block?
Which of the following best describes the underlying issue in all types of atrioventricular (AV) block?
First-degree AV block is always symptomatic and requires immediate intervention.
First-degree AV block is always symptomatic and requires immediate intervention.
What is the defining ECG characteristic of first-degree AV block regarding the PR interval?
What is the defining ECG characteristic of first-degree AV block regarding the PR interval?
In second-degree AV block type 1, there is a progressive prolongation of the ______ interval until a QRS complex is dropped.
In second-degree AV block type 1, there is a progressive prolongation of the ______ interval until a QRS complex is dropped.
Match the type of AV block with its corresponding ECG characteristic:
Match the type of AV block with its corresponding ECG characteristic:
A patient's ECG shows a consistent PR interval with intermittently dropped QRS complexes. Which type of AV block is most likely?
A patient's ECG shows a consistent PR interval with intermittently dropped QRS complexes. Which type of AV block is most likely?
Second-degree AV block type 1 is typically managed with immediate pacemaker insertion.
Second-degree AV block type 1 is typically managed with immediate pacemaker insertion.
List two potential causes of second-degree AV block type 2.
List two potential causes of second-degree AV block type 2.
Third-degree AV block is characterized by a complete lack of electrical communication between the atria and the ______.
Third-degree AV block is characterized by a complete lack of electrical communication between the atria and the ______.
Which of the following ECG findings is most indicative of third-degree AV block?
Which of the following ECG findings is most indicative of third-degree AV block?
Patients with third-degree AV block always require a permanent pacemaker.
Patients with third-degree AV block always require a permanent pacemaker.
Name two symptoms that might be seen in a patient with second-degree AV block type 2 or third-degree AV block.
Name two symptoms that might be seen in a patient with second-degree AV block type 2 or third-degree AV block.
A common management strategy for all types of AV block involves stopping ______ drugs.
A common management strategy for all types of AV block involves stopping ______ drugs.
Which complication is most likely to arise from untreated third-degree AV block?
Which complication is most likely to arise from untreated third-degree AV block?
An echocardiogram is useful in determining the specific subtype of AV block.
An echocardiogram is useful in determining the specific subtype of AV block.
Which of the following is NOT typically a cause of first-degree AV block?
Which of the following is NOT typically a cause of first-degree AV block?
Athletes are less likely to experience first-degree AV block due to their lower vagal tone.
Athletes are less likely to experience first-degree AV block due to their lower vagal tone.
Name two AV blocking drugs.
Name two AV blocking drugs.
A PR interval greater than ______ seconds is considered prolonged.
A PR interval greater than ______ seconds is considered prolonged.
Which of the following differentiates second-degree AV block type 1 from type 2?
Which of the following differentiates second-degree AV block type 1 from type 2?
Second-degree AV block type 2 is generally considered benign and requires no specific intervention.
Second-degree AV block type 2 is generally considered benign and requires no specific intervention.
What electrolyte imbalance is listed as a potential cause of second-degree AV block type 2?
What electrolyte imbalance is listed as a potential cause of second-degree AV block type 2?
In third-degree AV block, the atria and ventricles beat ______ of each other.
In third-degree AV block, the atria and ventricles beat ______ of each other.
Which of these conditions is least likely to cause third-degree AV block?
Which of these conditions is least likely to cause third-degree AV block?
First-degree AV block typically presents with symptoms like syncope and chest pain.
First-degree AV block typically presents with symptoms like syncope and chest pain.
What type of monitoring is often required for patients with second-degree AV block type 2?
What type of monitoring is often required for patients with second-degree AV block type 2?
Fibrosis and ______ of the conduction system is a common cause of AV block.
Fibrosis and ______ of the conduction system is a common cause of AV block.
Which of the following is the MOST important initial step in managing a patient with symptomatic third-degree AV block?
Which of the following is the MOST important initial step in managing a patient with symptomatic third-degree AV block?
A troponin level is useful in determining the type of AV block present.
A troponin level is useful in determining the type of AV block present.
Besides stopping AV-blocking medications, what other conservative measure can be considered for some patients with AV block?
Besides stopping AV-blocking medications, what other conservative measure can be considered for some patients with AV block?
The PR interval is measured from the beginning of the P wave to the beginning of the ______ complex.
The PR interval is measured from the beginning of the P wave to the beginning of the ______ complex.
Which of the following is the MOST common cause of AV block overall?
Which of the following is the MOST common cause of AV block overall?
All patients with first-degree AV block should be restricted from exercise.
All patients with first-degree AV block should be restricted from exercise.
What does 'FBC' stand for in the context of investigations for AV block?
What does 'FBC' stand for in the context of investigations for AV block?
In second-degree AV block type 2, the ______ interval remains consistent.
In second-degree AV block type 2, the ______ interval remains consistent.
Flashcards
Atrioventricular (AV) block
Atrioventricular (AV) block
Interruption of impulse transmission from atria to ventricles.
First-degree AV block
First-degree AV block
Consistent PR interval >0.20s; usually asymptomatic.
Second-degree AV block (type 1)
Second-degree AV block (type 1)
Progressive PR interval prolongation until a dropped QRS complex; usually benign.
Second-degree AV block (type 2)
Second-degree AV block (type 2)
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Third-degree (complete) AV block
Third-degree (complete) AV block
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ECG findings: First-degree AV block
ECG findings: First-degree AV block
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ECG findings: Second-degree type 1 AV block
ECG findings: Second-degree type 1 AV block
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ECG findings: Second-degree type 2 AV block
ECG findings: Second-degree type 2 AV block
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ECG findings: Third-degree AV block
ECG findings: Third-degree AV block
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First-degree AV block
First-degree AV block
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Causes of first-degree AV block
Causes of first-degree AV block
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Rhythm in first-degree AV block
Rhythm in first-degree AV block
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P wave in first-degree AV block
P wave in first-degree AV block
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PR interval in first-degree AV block
PR interval in first-degree AV block
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QRS complex in first-degree AV block
QRS complex in first-degree AV block
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Symptoms of Second/Third-Degree AV Block
Symptoms of Second/Third-Degree AV Block
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Management of AV block
Management of AV block
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Complications of AV block
Complications of AV block
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Most common cause of AV block
Most common cause of AV block
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Initial investigations for AV block
Initial investigations for AV block
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Drugs causing first-degree AV block
Drugs causing first-degree AV block
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Aetiology of first-degree AV block
Aetiology of first-degree AV block
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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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