2. Kamlya balgoon 2009

3. AV Blocks  AV block occur when the conduction of impulse through AV node decrease or stop  Prolonged P-R interval or more P waves than QRS  Block means DELAY. Causes  Medication  heart & valvular disease kemo 2009

4. 1- 1 st Degree AV Block It artial impulse conduct through AV node into ventricle are rate slower than normal It looks like the sinus rhythm but with prolonged P-R interval.. Normal and identical P waves. Each P is Followed by a QRS Normal QRS. P-R interval is 0.20 sec or more P: QRS ratio : 1 :1 Prolonged P-R interval kemo 2009

5. 2- 2 nd Degree AV Block a- Mobitz I Normal QRS. Identical P waves. P-R interval progressively prolongs until there is P not followed by a QRS P without QRS kemo 2009

6. 2- 2 nd Degree AV Block a- Mobitz II Identical P waves, Not every P is followed by a QRS. When there is a QRS, it has to be preceded by a P wave Atrial rate is regular. Check BP immediately. Every QRS preceded by a P waves Identical P waves kemo 2009

7. 4- 3 rd Degree AV Block ( Complete Heart Block ) No relationship between P waves and QRS complexes Check the BP immediately kemo 2009

8.  ECG: changes in heart rate, rhythm.  *Blood chemistry: electrolyte imbalance.  Nursing intervention:  Monitor pulse for irregular pattern or abnormally rapid or slow rate.  Observe for arrhythmias  continuous cardiac monitoring.  Assess cardiovascular, respiratory, and neurovascular status. Possible diagnostic findings kemo 2009

9.  Initiate cardiopulmonary resuscitation (CPR), if indicated, until other advanced cardiac life support  measures are available and successful.  Perform defibrillation early for ventricular tachycardia and ventricular fibrillation. kemo 2009 Nursing intervention

10.  Administer medications, oxygen, and I.V fluids, as needed.  Prepare for procedures, such as cardioversion  Monitor for predisposing factors (such as fluid and  electrolyte imbalance) and signs of drug toxicity, especially digoxin.  Monitor and record vital signs.  Maintain prescribed diet.  Maintain bed rest, until patient is stable.  Provide support to the patient and family. kemo 2009

12. Sinus Rhythm ( the only normal one ) QRS in second P r interval In second P waverhythmHeart rate second 0,12 0, 12 to 0,20 seconds Normal identical P waves RegularRate 60-100 b/pm

13. Sinus arrhythmia or sinus block QRS in second P r interval In second P waverhythmHeart rate o,20 second Normal 0,12 to o,20 second Normal identical P waves irregular rhythm Rate 60-100 b/pm A total beat missed

14. Premature A trial Complex ( PAC) QRS in second P r interval In second P waverhythmHeart rate Normal, ubnormal 0,12 0, 12 to 0,20 second different p wave, hidden in T wave irregular rhythm depend on underlying rhythm

15. Premature Ventricular Contraction ( PVC ) QRS in second P r interval In second P waverhythmHeart Rate duration 0.12 second or more. Bizarre, abnormal shape less than 0,12 second visibility p wave depend time of PVC may absent or in front QRS irregulardepend on rhythm PVCs ( early, wide and bizarre )

16. Premature Ventricular Contraction ( PVC ) QRS in second P r interval In second P waverhythmHeart Rate duration 0.12 second or more. Bizarre, abnormal shape less than 0,12 second visibility p wave depend time of PVC may absent or in front QRS irregulardepend on rhythm Multifocal ( different shape )

17. Premature Ventricular Contraction ( PVC ) QRS in second P r interval In second P waverhythmHeart Rate duration 0.12 second or more. Bizarre, abnormal shape less than 0,12 second visibility p wave depend time of PVC may absent or in front QRS irregulardepend on rhythm Unifocal

18. Premature Ventricular Contraction ( PVC ) QRS in second P r interval In second P waverhythmHeart Rate duration 0.12 second or more. Bizarre, abnormal shape less than 0,12 second visibility p wave depend time of PVC may absent or in front QRS irregulardepend on rhythm Couplets

19. Premature Ventricular Contraction ( PVC ) Bigeminy :-every other beat is PVC QRS in second P r interval In second P waverhythmHeart Rate duration 0.12 second or more. Bizarre, abnormal shape less than 0,12 second visibility p wave depend time of PVC may absent or in front QRS irregulardepend on rhythm

20. Premature Ventricular Contraction ( PVC ) Trigeminy :- every third complex is PVC QRS in second P r interval In second P waverhythmHeart Rate duration 0.12 second or more. Bizarre, abnormal shape less than 0,12 second visibility p wave depend time of PVC may absent or in front QRS irregulardepend on rhythm

21. ( Asystole ) kemo 2009 QRS in second PR interval In second P waverhythmHeart Rate No QRS.No No P wave irregularNo heart rate

22. 1- 1 st Degree AV Block AV block occur when the conduction of impulse through AV node decrease or stop Prolonged P-R interval kemo 2009 QRS in secondPR interval In second P waverhythmHeart Rate Normal QRS.P-R interval is 0.20 sec or more sinus rhythm, regular shape Depend on rhythm

23. 2- 2 nd Degree AV Block a- Mobitz I P without QRS kemo 2009 QRS in second PR interval In second P waverhythmHeart Rate Normal QRS. P-R interval progressively prolongs until there is P not followed by a QRS Shape depend on rhythm sinus rhythm but with prolonged P- R interval Depend on rhythm

24. 2- 2 nd Degree AV Block a- Mobitz II Every QRS preceded by a P waves Identical P waves kemo 2009 QRS in secondPR interval In second P waverhythmHeart Rate a QRS, it has to be preceded by a P wave. P-R interval is 0.20 sec or more IShape depend on rhythm irregularDepend on rhythm

25. 3 rd Degree AV Block ( Complete Heart Block ) QRS in second PR interval In second P waverhythmHeart Rate More p wave than QRS. Very irregular Depend on rhythm sinus rhythm, irregular Depend on escape & artial rhythm

26. kemo 2009