Atrioventricular block electrocardiogram: Difference between revisions

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== Overview ==
== Overview ==


== Electrocardiogram Findings ==
== Atrioventricular Block Electrocardiogram ==


<div align="left">
===First degree AV block EKG Examples===
<gallery heights="225" widths="225">
Shown below is an EKG image of first degree AV block. With PR interval exceeding 200 msec and prolonged PR conduction, a more appropriate classification for this conduction disturbance may be the result of conduction delay within the atrium, AV node, bundle of His or bundle branches. Prolongation of the PR interval most often indicates AV nodal conduction delay.
Image:LAE.jpg|First degree AV block is a misnomer in that every P wave is conducted to the ventricles, however, with a PR interval exceeding 200 msec. Prolonged PR conduction, a more appropriate classification for this conduction disturbance, may be the result of conduction delay within the atrium, AV node, bundle of His or bundle branches. Prolongation of the PR interval most often indicates AV nodal conduction delay.  
[[Image:LAE.jpg|center|500px]]
Image:2to1AVBlock1.jpg|Two-to-one AV block can represent benign block within the AV node or disease of the His-Purkinje system. Certain electrocardiographic features and maneuvers can help in distinguishing where the location of block exists. A long PR interval with a narrow QRS suggests an intranodal block. A short PR interval with intraventricular conduction delay or bundle branch block suggests disease below the node. Responses to atropine, exercise and carotid sinus massage can be helpful in diagnosis. Atropine will improve AV nodal conduction but will worsen block within diseased His-Purkinje fibers. Exercise has a similar effect, improving conduction in cases where block exists only in the node, but worsening when block is subnodal. Alternatively, Carotid Sinus Massage will slow conduction when block occurs in the AV node, but will improve conduction in diseased His-Purkinje tissue by allowing for refractoriness to recover
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</gallery>
Shown below is an EKG image showing sinus rhythm with a prolonged pr interval (>120ms.) which is first degree A/V block. There is also a left axis deviation (axis between -30 and -90 degrees) with r waves in the inferior leads. This axis deviation is consitent with a left anterior fasicular block.
</div>
[[File:AVBlockEKG.jpg|center|500px]]


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===Second degree AV block EKG Examples===
Shown below is an EKG showing sinus rhythm with a prolonged pr interval (>120ms.) which is first degree A/V block. There is also a left axis deviation (axis between -30 and -90 degrees) with r waves in the inferior leads. This axis deviation is consitent with a left anterior fasicular block.


[[File:AVBlockEKG.jpg|center|500px]]
=====Mobitz I Second degree AV block EKG Examples=====
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Shown below is an EKG image of ventriculophasic reflex during second degree AV block Mobitz I. The PP interval that follow upon the blocked sinus beat is prolonged.
[[File:Ventriculophasic_Reflex.jpg|500px|center]]
=====Mobitz II Second degree AV block EKG Examples=====
Shown below is an EKG image of two-to-one AV block, which can represent benign block within the AV node or disease of the His-Purkinje system. Certain electrocardiographic features and maneuvers can help in distinguishing where the location of block exists. A long PR interval with a narrow QRS suggests an intranodal block. A short PR interval with intraventricular conduction delay or bundle branch block suggests disease below the node. Responses to atropine, exercise and carotid sinus massage can be helpful in diagnosis. Atropine will improve AV nodal conduction but will worsen block within diseased His-Purkinje fibers. Exercise has a similar effect, improving conduction in cases where block exists only in the node, but worsening when block is subnodal. Alternatively, Carotid Sinus Massage will slow conduction when block occurs in the AV node, but will improve conduction in diseased His-Purkinje tissue by allowing for refractoriness to recover.
[[Image:2to1AVBlock1.jpg|500px|center]]


==Sources==
==Sources==
 
Copyleft images obtained courtesy of ECGpedia, http://en.ecgpedia.org/index.php?title=Special:NewFiles&offset=&limit=500
Copyleft images obtained courtesy of ECGpedia, http://en.ecgpedia.org/index.php?title=Special:NewFiles&dir=prev&offset=20080806182927&limit=500


==References==
==References==

Revision as of 14:11, 16 October 2012

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Atrioventricular Block Electrocardiogram

First degree AV block EKG Examples

Shown below is an EKG image of first degree AV block. With PR interval exceeding 200 msec and prolonged PR conduction, a more appropriate classification for this conduction disturbance may be the result of conduction delay within the atrium, AV node, bundle of His or bundle branches. Prolongation of the PR interval most often indicates AV nodal conduction delay.


Shown below is an EKG image showing sinus rhythm with a prolonged pr interval (>120ms.) which is first degree A/V block. There is also a left axis deviation (axis between -30 and -90 degrees) with r waves in the inferior leads. This axis deviation is consitent with a left anterior fasicular block.

Second degree AV block EKG Examples

Mobitz I Second degree AV block EKG Examples

Shown below is an EKG image of ventriculophasic reflex during second degree AV block Mobitz I. The PP interval that follow upon the blocked sinus beat is prolonged.

Mobitz II Second degree AV block EKG Examples

Shown below is an EKG image of two-to-one AV block, which can represent benign block within the AV node or disease of the His-Purkinje system. Certain electrocardiographic features and maneuvers can help in distinguishing where the location of block exists. A long PR interval with a narrow QRS suggests an intranodal block. A short PR interval with intraventricular conduction delay or bundle branch block suggests disease below the node. Responses to atropine, exercise and carotid sinus massage can be helpful in diagnosis. Atropine will improve AV nodal conduction but will worsen block within diseased His-Purkinje fibers. Exercise has a similar effect, improving conduction in cases where block exists only in the node, but worsening when block is subnodal. Alternatively, Carotid Sinus Massage will slow conduction when block occurs in the AV node, but will improve conduction in diseased His-Purkinje tissue by allowing for refractoriness to recover.

Sources

Copyleft images obtained courtesy of ECGpedia, http://en.ecgpedia.org/index.php?title=Special:NewFiles&offset=&limit=500

References

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