Dorian prefers to approach AV block by thinking about the location of the block, whether the block occurs in the proximal conducting system (AV node) or the distal conducting system (His-Purkinje). Dorian’s approach to AV block: proximal vs. These patients should be considered for admission for observation on telemetry. Pearl: Lyme carditis can present with new, long 1 st degree AV block and may degenerate into complete heart block. However, if the patient presents with an acute cardiac-related symptom and the 1 st degree AV block is new, it may not be benign. Inferior MI with RV extension or posterior MIįor the most part, 1 st degree AV block with a prolonged PR interval is benign.B-blocker, calcium channel blocker, digoxin poisoning.Marked sinus bradycardia with complete AV block with junctional escape. The QRS is typically narrow, and P waves can be retrograde, narrow or absent. In some circumstances, symptomatic sinus bradycardia may need to be treated if the quality of life of the patient is significantly impacted.Ī junctional rhythm occurs when the electrical activity of the SA node is blocked or is less than the automaticity of the AV node/His bundle. This is transient and the treatment is reassurance. The duration of the pause should not necessarily be a cause for concern. Symptomatic sinus bradycardia and syncope of the vasovagal type in young healthy people may be associated with very long pauses (>30 seconds).
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