Heart Blocks

Saleh Al Sulayyim
 Objectives
• Review specific components of the electrical conduction system of the
heart.
• Discuss and identify Sinoatrial (SA) Blocks.
• Discuss and identify Atrioventricular Blocks.
• First-Degree AV Block.
• Second-Degree AV Block:
• Type I (Mobits or Wenckebach).
• Type II (Mobits II).
• Third-Degree AV Block.
• P-wave:
• Initial spread of depolarization across the right and
left atria.
• PR interval:
• Delay in conduction that takes place in the AV
node.
• QRS complex:
• Depolarization of the ventricular myocardium.
• QT interval:
• Time for complete ventricular repolarization.
• T-wave:
• Ventricular repolarization.
• U-wave:
• Final phase of Purkinje fiber repolarization.
 Introduction
• Heart blocks:
• electrical conduction system disorders.
• These rhythms occur when the electrical impulses that originate in the
sinoatrial (SA) node are blocked or delayed in an area of the heart’s
electrical conduction system.
1. SA Blocks
 Sinus Block

• Rate • PR Interval
• Usually normal (60-100) • 0.12–0.20 seconds and constant
• Rhythm • QRS Complex
• Irregular – distance will equal that of two other • Normal, duration of <0.12 seconds
beats
• P waves
• Normal, upright, uniform, one precedes each
QRS complex
2. AV Blocks
 Atrioventricular Blocks
• Atrioventricular (AV) blocks reflect delay or interruption of impulses
through the AV junction due to disease in this region.
• They are traditionally divided into three categories:
• first, second, and third degree.
• This pathological block, caused by such conditions as
• ischemia, necrosis, degenerative diseases of the conduction system, and drug
toxicity, is different from
• the physiological AV block that occurs in atrial flutter and fibrillation.
 First Degree AV Heart Block

• PR Interval > .20 seconds

• Relatively common with:
• Athletes
• Beta-Blockade
 Second Degree AV Heart Block

• Type I (Mobits or Wenckebach).

• Type II (Mobits II).
 Type I (Mobits or Wenckebach)

• Occurs at AV Node level

• Gradual lengthening of the P-R Interval
(resistance) - until the A-V node takes a
full rest…and “drops a beat”.
 Type II (Mobits II)

• Occurs at the Purkinje level (Purkinje

system starts at the His Bundle)
• More significant clinically
• More likely to develop into 3o AV block
• Tx:
• Usually cardiac pacing
 3 Degree AV Heart Block
rd

• Complete AV Block, Complete AV Dissociation

• Complete block in the upper AV node leaves junctional foci to
escape and pace the ventricles
• What is the inherent pacing rate of the AV junction?
• Therefore:
• 40 - 60 / minute
• Usually narrow QRS
 3rd Degree AV Heart Block
• Both the atrial rate and the
ventricular rate are REGULAR
but INDEPENDENT
• There is no “association”
between the atria and the
ventricles
• “P” does not CAUSE the “QRS”
Thank You