Second degree AV block type II: Difference between revisions
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**[[Bradycardia]] | **[[Bradycardia]] | ||
**[[Altered mental status]] | **[[Altered mental status]] | ||
**[[Syncope]], weakness | **[[Syncope]], [[weakness]] | ||
==Differential Diagnosis<ref>Hampton, JR. The ECG in Practice (5th edition), Churchill Livingstone 2008.</ref><ref>Wagner, GS. Marriott’s Practical Electrocardiography (11th edition), Lippincott Williams & Wilkins 2007.</ref>== | ==Differential Diagnosis<ref>Hampton, JR. The ECG in Practice (5th edition), Churchill Livingstone 2008.</ref><ref>Wagner, GS. Marriott’s Practical Electrocardiography (11th edition), Lippincott Williams & Wilkins 2007.</ref>== | ||
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*[[Myocarditis]] | *[[Myocarditis]] | ||
*[[Lyme disease]] | *[[Lyme disease]] | ||
* | *Lenegre's disease | ||
* | *Lev's disease | ||
*[[SLE]] | *[[SLE]] | ||
*[[Systemic sclerosis]] | *[[Scleroderma|Systemic sclerosis]] | ||
*[[Amyloidosis]] | *[[Amyloidosis]] | ||
*[[ | *[[Hemochromatosis]] | ||
*[[Sarcoidosis]] | *[[Sarcoidosis]] | ||
*[[Hyperkalemia]] | *[[Hyperkalemia]] | ||
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[[File:Type 2 - buried p wave.JPG|thumbnail|2nd degree AVB, 2:1 conduction, LBBB with buried p-waves in t-waves]] | [[File:Type 2 - buried p wave.JPG|thumbnail|2nd degree AVB, 2:1 conduction, LBBB with buried p-waves in t-waves]] | ||
===Workup=== | ===Workup=== | ||
*Evaluate for underlying pathology | |||
*[[ECG]] | *[[ECG]] | ||
*Labs | *Labs | ||
Revision as of 16:07, 26 September 2019
Background
- A disturbance of atrial impulse conduction, usually in the distal conduction system[1]
- Often associated with structural heart disease
- Significant risk of hemodynamic instability, symptomatic bradycardia, and decompensation into Third Degree AV Block and subsequent cardiac arrest
- Risk of asystole 35% per year[2]
Clinical Features
- Most patients are asymptomatic
- Symptomatic patients may present with:
Differential Diagnosis[3][4]
- Anterior MI
- Rheumatic fever
- Myocarditis
- Lyme disease
- Lenegre's disease
- Lev's disease
- SLE
- Systemic sclerosis
- Amyloidosis
- Hemochromatosis
- Sarcoidosis
- Hyperkalemia
- Toxicology
AV blocks
- First degree AV block
- Second degree
- Third degree AV block
- AV dissociation without complete heart block
Evaluation
Workup
Diagnosis
- ECG findings:
- Fixed PR interval for conducted QRS complexes
- Intermittent non-conducted P-waves
- P waves march through (beware of p-waves consistently buried in T-waves)
Management
- If symptomatic, standard ACLS guidelines for symptomatic bradycardia includes[5]
- Atropine 0.5mg IV q3-5min PRN
- Transcutaneous pacing, followed by transvenous pacing
- Treat underlying etiology
- Avoid AV nodal blocking agents (e.g. β-blockers)
Disposition
- Admission for pacing and monitoring
- Subsequent permanent pacemaker
- 2:1[5] and 3:1 blocks
- May be unable to determine if Second Degree AV Block Type I or type II
- Admit to cardiology and assume type II
See Also
References
- ↑ Jones, W., and Napier, L. Atrioventricular block second-degree. Statpearls. Jan 2019
- ↑ Burns E. AV Block: 2nd degree, Mobitz II. Life in the Fast Lane. http://lifeinthefastlane.com/ecg-library/basics/mobitz-2/.
- ↑ Hampton, JR. The ECG in Practice (5th edition), Churchill Livingstone 2008.
- ↑ Wagner, GS. Marriott’s Practical Electrocardiography (11th edition), Lippincott Williams & Wilkins 2007.
- ↑ 5.0 5.1 Sovari AA et al. Second-Degree Atrioventricular Block Treatment & Management. eMedicine. Apr 28, 2014. http://emedicine.medscape.com/article/161919-treatment#showall.