Critical Care: Heart Blocks

**With heart blocks, the AV node is sick. Therefore the P-R INTERVAL will be abnormal.

I. FIRST DEGREE HEART BLOCK

  • HEART RATE: Variable
  • RHYTHM: Regular
  • P WAVES: Normal
  • P-R INTERVAL: consistently longer than 0.20 seconds
  • QRS WIDTH: Usually normal
  • INTERVENTIONS: Continue to monitor, IV, O2

II. SECOND DEGREE HEART BLOCK, TYPE I (WENCKEBACH, MOBITZ I)

  • HEART RATE: Variable
  • RHYTHM: Irregular
  • P WAVES: Normal; # of P’s > # of QRS
  • P-R INTERVAL: progressive lengthening on consecutive beats until you drop one QRS
  • QRS WIDTH: Usually normal, absent when blocked
  • INTERVENTIONS: Continue to monitor, IV, O2

III. SECOND DEGREE HEART BLOCK, TYPE II (MOBITZ II)

  • HEART RATE: Variable, slow
  • RHYTHM: Irregular
  • P WAVES: Normal; # of P’s > # of QRS
  • P-R INTERVAL: consistent when it happens, absent with blocked beats
  • QRS WIDTH: Usually normal, absent when blocked
  • INTERVENTIONS: transcutaneous pacemaker; *closely monitor, as it may lead to complete heart block!

IV. THIRD DEGREE (COMPLETE) HEART BLOCK

  • HEART RATE: Variable, slow
  • RHYTHM: Regular
  • P WAVES: Normal; # of P’s > # of QRS
  • P-R INTERVAL: Random
  • QRS WIDTH: Wide
  • INTERVENTIONS: transcutaneous pacemaker; may then need permanent pacemaker
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