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Understanding Atrioventricular Blocks: Diagnosis and Management Strategies

Explore the degrees of AV blocks, differentiate nodal and infranodal blocks, and learn about management strategies through case studies. Understand first, second, and third-degree blocks with ECG differentiations for accurate diagnosis. Discover the importance of identifying the location of the block for appropriate treatment interventions. Enhance your knowledge of AV block management using drugs and devices. Improve your evaluation skills for heart blocks to provide effective care.

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Understanding Atrioventricular Blocks: Diagnosis and Management Strategies

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  1. Atrioventricular Block Dr Alex Byrne

  2. Source

  3. Aims • Discuss the different degrees of AV blocks • Discuss the difference between nodal and infranodal blocks • Give an overview of the core management strategies • Go through some cases

  4. What is an Atrioventricular block? • Abnormality in electrical conduction between atria and ventricles • Degree tends to be used to indicate severity • Can occur in AV node, His bundle, or both RBB and LBB levels

  5. Anatomy

  6. ECG

  7. First degree AV block

  8. Second degree AV block

  9. Third degree AV block

  10. Differentiating between 2nd and 3rd degree AV block • If the RR interval is irregular, some atrioventricular conduction can be assumed and second degree block is present. • If the RR interval is regular and there is a constant PR interval then this indicates second degree atrioventricular block. • If there is a regular RR interval and variable PR interval then this indicates third degree block with an escape rhythm generated by a lower site.

  11. Quick recap • 1st degree heart block – prolonged PR (>0.2s) but every p wave followed by qrs • 2nd degree heart block – one or more but not all atrial impulses fail to reach ventricles • type 1 – progressive lengthening before drop • Type 2 – random drops • 3rd degree heart block – no atrial impulses conducted to ventricles

  12. Location of AV block

  13. AV nodal block

  14. AV nodal block

  15. Infranodal block

  16. Algorithm for identifying location of AV block on ECG

  17. Case 1

  18. Case 2

  19. Case 3

  20. Case 4

  21. Management strategies • Drugs • Devices

  22. Devices

  23. Summary • Use a systematic approach to the evaluation heart blocks • Use pen and paper • Try and ID the location in second degree blocks as infranodal has worse outcomes than nodal • Be aware of different devices for different situations

  24. Thank you!

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