HEART PHYSIOLOGY

(ARRYTHMIAS)
BY DR. MUDASSAR ALI ROOMI (MBBS, M. PHIL)

SA NODAL HEART BLOCK:

impulse from SA node is blocked before it enters the atria Results in standstill of atria the ventricles pick up a new rhythm, the impulse usually originating spontaneously in the AV node. that the rate of the ventricular QRS-T complex is slowed but not otherwise altered. Cause: Strong vagal stimulation Treatment: can be relieved by giving atropine (anticholinergic drug).

AV BLOCK
conduction of impulses from the atria to ventricles is either slowed down or completely blocked and the block is in AV node or in AV bundle. Causes of AV block:
Ischemia compression of conductive tissue by a scarred or fibrosed portion of myocardium. Inflammation of AV node or AV bundle: Diphtheria, rheumatic fever and myocarditis Strong vagal stimulation.

AV block is of two types: 1. Incomplete (partial) AV Block:

First degree AV block Second degree AV block

2.

Complete AV block:

First degree AV block All impulses are conducted from atria to ventricles but there is prolonged PR interval i.e. > 0.20 sec Usually because of ischemia Treatment: Usually no need to do any intervention

First Degree Heart Block

AV Node SA Node

H
Delay

T
Prolonged P-R Interval

Prolonged P-R Interval

Copyright 2006 by Elsevier, Inc.

Second degree AV block

MOBITZ TYPE I 2ND DEGREE AV BLOCK:

also called Wenckebach phenomenon. There is progressive prolongation of PR interval in successive heart beats, till a heart beat is dropped.

MOBITZ TYPE II 2ND DEGREE AV BLOCK:

PR interval is permanently or constantly prolonged. PR interval may be> 0.45 sec There is 2:1 rhythm or 3:1 rhythm i.e. every 2nd or 3rd impulse from atria is conducted to ventricles. In ECG we find that after every 2 or 3 P waves there is a QRS complex.

MOBITZ II HEART BLOCK

Second Degree Heart Block

AV Node
SA Node

H
Intermittent Block

Blocked Conducted Blocked

Conducted

Copyright 2006 by Elsevier, Inc.

 conduction of impulses from Atria to ventricles is completely blocked. Ventricles start their own rhythm at a slower rate. So, atria beat independently with the SA nodal rhythm (70-80 bpm) and ventricles beat with their own rhythm (15-40 bpm). Complete dissociation b/w atria and ventricles *** In ECG there is no association between P wave and QRS complex. Treatment: atropine, pacemaker

Complete (Third Degree) AV block

STOKES-ADAMS SYNDROME
Refers to sudden transient episode of syncope due to 3rd degree heart block Ventricle stop contracting for 530 seconds due to override suppression After some time ventricles pick up their own rhythm (15-40 bpm)= ventricular escape Clinical features: bradycardia, Cannon a waves visible in the jugular veins, Unconsciousness (syncope) 3rd degree AV nodal block comes and goes with variable interval in b/w