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Heart block help

Posted

Specializes in med surg. Has 15 years experience.

I get first degree, prolonged PR, no really harm to patient.

THird degree complete av dissociation, needs help, pace

but second degrees are stumping me, any easy way to remember these , any help you can give me appreciated

al7139, ASN, RN

Specializes in Emergency. Has 5 years experience.

Hi Here is how I remember:

Second degree HB (Wenckebach or Mobitz I) The PRI lengthens (Longer, longer, then it blocks, now you have a Wenckebach) until one QRS is dropped (you have a P wave without a QRS every 3rd beat or so).

Second Degree HB (Type II or Mobitz II or 2nd degree AV block) You will have an extra P wave without a QRS, but the PRI is always constant with or without a P wave. More P waves than QRS complexes.

Hope this helps.

Amy

rndbest

Specializes in critical care,er,orthopedic,cardiac. Has 31 years experience.

ok second degree weenkebach is pr getting longer and longer then dropped beat and secondegree type 2 is pr's are constant

jadu1106

Has 4 years experience.

i posted this last year in another thread. hope it helps you!

here is something i got from a co-worker who was attending nursing school last year.

it is actually on paper, not a file, with a husband/wife picture but i wanted to write it on here.

the story of the av block family

key:

p wave = wife

qrs = husband

pacer = counseling

normal sinus rhythm:

the wife (p wave) waits at home for the husband (qrs). the husband (qrs) come homes on time every night.

1st degree av block:

the wife (p wave) is waiting at home. the husband (qrs) comes home late every night, but he always comes home and its at the same time every night.

2nd degree block type i (weinkebach):

the wife (p wave) is waiting at home. the husband (qrs) come home later and later every night until one night he doesn't come at all.

note: husband (qrs) must come home at least 2 nights in a row to see this pattern.

2nd degree av block type ii:

the wife (p wave) is waiting at home. sometimes the husband (qrs) comes home, sometimes he doesn't. when he does come home, its always at the same time.

note: this is usually more serious than type i (weinkebach) and will sometimes require counseling (pacing).

3rd degree av block:

wife (p wave) is no longer waiting at home. she and her husband (qrs) are now both on separate schedules and have no relationship and they are no longer talking. each spouse has a regular, individual schedule.

note: this frequently requires counseling in the form of a temporary or permanent pacer.

hope this helps you! :) i thought it was pretty neat!

jadu1106

i posted this last year in another thread. hope it helps you!

here is something i got from a co-worker who was attending nursing school last year.

it is actually on paper, not a file, with a husband/wife picture but i wanted to write it on here.:

the story of the av block family

key:

p wave = wife

qrs = husband

pacer = counseling

normal sinus rhythm:

the wife (p wave) waits at home for the husband (qrs). the husband (qrs) come homes on time every night.

1st degree av block:

the wife (p wave) is waiting at home. the husband (qrs) comes home late every night, but he always comes home and its at the same time every night.

2nd degree block type i (weinkebach):

the wife (p wave) is waiting at home. the husband (qrs) come home later and later every night until one night he doesn't come at all.

note: husband (qrs) must come home at least 2 nights in a row to see this pattern.

2nd degree av block type ii:

the wife (p wave) is waiting at home. sometimes the husband (qrs) comes home, sometimes he doesn't. when he does come home, its always at the same time.

note: this is usually more serious than type i (weinkebach) and will sometimes require counseling (pacing).

3rd degree av block:

wife (p wave) is no longer waiting at home. she and her husband (qrs) are now both on separate schedules and have no relationship and they are no longer talking. each spouse has a regular, individual schedule.

note: this frequently requires counseling in the form of a temporary or permanent pacer.

hope this helps you! :) i thought it was pretty neat!

jadu1106

omg i loveeeeeeeeeeee this and it totallly makes sense to me!

mmm

can we use the av family with other rhythms as well? heres my attempt...

[basic senerio, wife is starting to get ticked off cause husband doesnt come home on time (heartblock) and now the husband tries to clean up his act by being on time.

junctional rhythm:

p: if the wife is waiting at home, she likes to hide from her husband(inverted wave?)

qrs: the husband comes back home on the sametime..

v tach:

p: wife does not wait at home any more.

qrs: the husband comes home at the same time and tends to stay up longer than usual waiting for his wife?. (prolonged qrs):D

vent fib:

broken marriage-

p: wife never comes home, doesnt wait for husband

qrs: husband comes and goes hoping wife will be home (...so sad haha)

asystole:

divorce:

no ones comes home...both have given up ---------------------- :down:

haha okay- that was fun. not sure if it'll make sense to anyone else, but i actually think this lil drama of mine will help me on tomorrows ekg quiz :) gluck! :nurse:

i posted this last year in another thread. hope it helps you!

here is something i got from a co-worker who was attending nursing school last year.

it is actually on paper, not a file, with a husband/wife picture but i wanted to write it on here.

the story of the av block family

key:

p wave = wife

qrs = husband

pacer = counseling

normal sinus rhythm:

the wife (p wave) waits at home for the husband (qrs). the husband (qrs) come homes on time every night.

1st degree av block:

the wife (p wave) is waiting at home. the husband (qrs) comes home late every night, but he always comes home and its at the same time every night.

2nd degree block type i (weinkebach):

the wife (p wave) is waiting at home. the husband (qrs) come home later and later every night until one night he doesn't come at all.

note: husband (qrs) must come home at least 2 nights in a row to see this pattern.

2nd degree av block type ii:

the wife (p wave) is waiting at home. sometimes the husband (qrs) comes home, sometimes he doesn't. when he does come home, its always at the same time.

note: this is usually more serious than type i (weinkebach) and will sometimes require counseling (pacing).

3rd degree av block:

wife (p wave) is no longer waiting at home. she and her husband (qrs) are now both on separate schedules and have no relationship and they are no longer talking. each spouse has a regular, individual schedule.

note: this frequently requires counseling in the form of a temporary or permanent pacer.

hope this helps you! :) i thought it was pretty neat!

jadu1106

omg-i am so saving this for when i need it!

Daytonite, BSN, RN

Specializes in med/surg, telemetry, IV therapy, mgmt. Has 40 years experience.

you really need to understand the normal pathway of the electrical conduction of the heart because blocks are a disruption of that conduction. if you understand the pathophysiology, then the symptoms make more sense.

very simply, this is a breakdown in the electrical conduction of the electrical impulse that is generated by the sa node of the heart. you need to understand the normal conduction pathway of an electrical impulse as it makes its way through the heart. the problem in mobitz ii type of second degree heart block is abnormal conduction of the electrical impulse at the av node. the sa node in the atrium is working just fine. however, periodically, the av node doesn't let the impulse through to the ventricles , or blocks the impulse, so there is no corresponding ventricular response (qrs complex) to complete the heartbeat. the best i could find of the pathophysiology of this was that it is due to faulty cell metabolism below the av node with no further explanation (page 1084, pathophysiology: the biologic basis for disease in adults and children, third edition, by kathryn l. mccance and sue e. heuther). the causes of this are potassium levels below 3.5 meq/l, antidysrrhythmics and cyclic antidepressants. mobitz ii blocks can occur in cad, mis, hypoxia, increased preload, valvular surgery, valvular disease and diabetes. it is more serious than mobitz i block because it can progress to type iii block. the treatment for it is a pacemaker if drug therapy does not work.

wowwwwwwwwww thanks a lot for the infooooo :))

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