degenerative complete heart block: basics and diagnostics
TRANSCRIPT
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Most images used are either mine, used under a creative commons license or in the public domain. Other images are from freely available medical journals or blogs with source or URLs stated in the slide.
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SA node: 60 to 100 bpm
AV Junction: 40 to 60 bpm
Ventricle: <40 bpm
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SA node: 60 to 100 bpm
AV Junction: 40 to 60 bpm
Ventricle: <40 bpm
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Image from wikimedia users Madhero88 and Angelito7: https://en.wikipedia.org/wiki/Heart_block#/media/File:ConductionsystemoftheheartwithouttheHeart-en.svg
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Images from Wikimedia User Fae: https://upload.wikimedia.org/wikipedia/commons/6/6d/A_doctor_taking_the_pulse_of_a_gouty_bachelor_surrounded_by_Wellcome_V0010995.jpg and https://upload.wikimedia.org/wikipedia/commons/6/69/A_physician_taking_the_pulse_of_a_female_patient_who_is_touc_Wellcome_V0016032.jpg
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Image from Dr. S. Venkatesan: https://drsvenkatesan.files.wordpress.com/2013/08/irregular-cannon-waves-in-jvp-complete-heart-block.gif
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3rd Degree or Complete Heart Block
• None of the P waves are conducted
• P waves and QRS complexes occur independently of each other
• R-R intervals are usually regular (junctional or ventricular escape rhythm)
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Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/
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Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/
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SA node: 60 to 100 bpm
AV Junction: 40 to 60 bpm
Ventricle: <40 bpm
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Complete heart block: http://commons.wikimedia.org/wiki/User:Jer5150
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• R-R intervals are usually regular (escape rhythm)
• More P waves than R waves
• “PR” intervals are not constant / no pattern
• Escape rhythm can be junctional or ventricular
Complete heart block strip from Wikimedia user MoodyGroove: http://en.wikipedia.org/wiki/User:MoodyGroove
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Escape Rhythms
• Junctional rhythm (40 to 60 bpm)
– Narrow QRS
– Retrograde P waves shortly before or after QRS, if any
• Ventricular rhythm (<40 bpm)
– Wide, “bizarre” QRS complexes
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Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/
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Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/
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Image from Flickr User Helge V. Keltel: https://www.flickr.com/photos/17088227@N00/7147926407
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Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/
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From https://en.wikipedia.org/wiki/Dialysis#/media/File:Patient_receiving_dialysis_03.jpg
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Pills Image from https://www.flickr.com/photos/emagineart
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Diagnosis and Management of Cardiac Amyloidoses. Circulation.2005; 112: 2047-2060
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Image from wikimedia User Kalumet: https://commons.wikimedia.org/wiki/File:Dilated_cardiomyopathy_B-Mode.jpg
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Holter image from Wikimedia user Misscurry: https://en.wikipedia.org/wiki/Holter_monitor#/media/File:Alex_CM4000.jpg
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Brignole et al. J Am Coll Cardiol 2011;58:167–73
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Image from From Wikimedia user: https://commons.wikimedia.org/wiki/User:Stevenfruitsmaak
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SA node: 60 to 100 bpm
AV Junction: 40 to 60 bpm
Ventricle: <40 bpm
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Images
• Cover image originally Rainbow Heart by Bill Ward: https://www.flickr.com/photos/billward. Converted to black and white to sort of fit the bad pun and subject matter.
• Heart image with conduction system: Public Domain image from Gray’s Anatomy
• QRS complex: Public Domain image from Wikipedia user http://en.wikipedia.org/wiki/User:Agateller
• Road Block sign: http://en.wikipedia.org/wiki/File:Road_block.jpg
• Complete heart block: http://commons.wikimedia.org/wiki/User:Jer5150
• Complete heart block strip: http://en.wikipedia.org/wiki/User:MoodyGroove
• Junctional rhythm: http://www.flickr.com/photos/nottinghamvets/
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