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Second Degree Heart Block, Dysrhythmias, Reference: CNE, M. M., Jeffrey…
Second Degree Heart Block
Type 2- (Mobitz 2)
P Waves (Atrial Rate Regular)
EKG Characteristics
NO QRS (R wave) after P wave
More P Waves than QRS Complexes present
R waves IRREGULAR and QRS complex will be missing
Advances to 3rd degree HB if untreated- Pace maker is needed for treatment
AV block occurs in ratios 2:1 and 3:1; 2 P waves to 1 QRS, 3 P waves to 1 QRS
Related/Associated Conditions
Rheumatic Heart Disease, CAD, Anterior MI, and drug toxicity
Treatment
Transcutaneous Pacing or a Temporary Pacemaker
A Permanent Pacemaker may be needed if patient becomes symptomatic (hypotension, angina)
Type 1- (Wenckebach or Mobitz 1)
EKG Characteristics
Lengthening PR Interval (greater than 0.20 sec.) gradually until there is no R wave (QRS complex) and R wave is IRREGULAR
P Waves are present but are IRREGULAR- THEY do not evenly measure.
P Waves are present and IRREGULAR, PR INTERVAL *CYCLIC LENGTHENING is only present in this one.
Associate Conditions
: Myocardial Ischemia, AV conduction issue, CAD
Treatment
Symptomatic
Pt: Atropine or Temporary pacemaker
Asymptomatic
: observe the rhythm, have transcutaneous pacemaker ready
Wenckebach Poem:
WINKY_WINKY_WINKY_DROP
Basically it consists of a full P-T interval 3 times, on the 4th time only a P appears and no QRS or T, then back to a full P-T interval repeat
HELPFUL LINK:
https://youtu.be/SPF0kOoYuLg
References- Pg. 795 in Lewis Medical Surgical Book 9th Edition
Dysrhythmias
First-Degree Heart Block
Every (PR) impulse is conducted to the ventricles, but the time of PR to QRS is prolonged; Pts are usually asymptomatic
Related/Associated Conditions
MI, CAD, Rheumatic Fever
Electrolyte Imbalance (especially Hypokalemia )
Hyperthyroidism
EKG Characteristics
Normal HR
Regular Rhythm
P wave present & normal
PR interval > 0.20 secs
QRS normal shape & duration
Treatment
No treatment
Considered treating related/associate conditions
Nursing Interventions
Monitor patients for changes in heart rhythm, like worsening AV heart blocks
excerpt from Lewis Med Surg Nursing Chapter 35
Reference: CNE, M. M., Jeffrey Kwong, D., Roberts, D., Hagler, D., & Dnp, C. R. (2019). Lewis's medical-surgical nursing E-book: Assessment and management of clinical problems (11th ed.). Elsevier Health Sciences.
