Cardiology- AVB, BBB, SSS, WAP, MAT, WPW

Prolonged PR interval
1st degree AVB
(if the R is far from P)

Progressive lengthening of PR interval until absent beat
2nd degree AVB, Wenckebach
(longer, longer, longer, drop)

Random absent beats
2nd degree AVB, Mobitz 2
(some P’s don’t go through)

Complete AV dissociation
3rd degree AVB
(P and Q don’t agree)

S/S and Tx for 1st degree AVB
Asx, No tx

S/S and Tx for Wenckebach
Weakness, fatigue, lightheaded, syncope
Permanent pacemaker only definitive therapy

S/S and Tx for Mobitz 2
Weakness, fatigue, lightheaded, syncope
Temporary transthoracic > permanent pacemaker

S/S and Tx for 3rd degree AVB
Weakness, fatigue, lightheaded, syncope, HF, Vtach, Vfib, asystole
Temporary transthoracic > permanent pacemaker
Atropine for bradyC

Alternating tachyC/bradyC
Sick sinus syndrome

Aerosol propellant abuse
Sick sinus syndrome

Caused by collagen vascular d/o
Sick sinus syndrome

Causes of SSS
Digitalis, BB, CCB, aerosol abuse, collagen vascula d/o

Spontaneous sinus bradyC, pause, arrest
Sick sinus syndrome

SSS tx
Permanent pacing + AICD

His-Purkinje
2nd degree AVB, Mobitz 2

Progresses to complete heart block
2nd degree AVB, Mobitz 2

Requires permanent pacemaker
SSS, Mobitz 2, complete HB

1st line tx of symptomatic bradyC
Atropine

rSR’ in V1,2
RBBB

RsR’ in V5,6
LBBB

Symptomatic tachyC
Cardioversion

3 different P wave morphologies 60-100 bpm
WAP: Wandering Atrial Pacemaker

3 different P wave morphologies > 100 bpm
MAT: Multifocal Atrial TachyC

MCC and tx of MAT: Multifocal Atrial TachyC
COPD, tx w/ O2 and ventilation

Ineffective in MAT tx
Electrical cardioversion

Delta wave, or slurred QRS upstroke
WPW

WPW tx
Vagal > procainamide/amiodarone > radiofrequency ablation

Bundle of Kent
WPW

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