10/19/2020

The Human Heart

CARDIAC
RHYTHM
DISORDERS

REVIEW OF THE
PHYSIOLOGY OF THE
HEART Pacemakers of the heart
a. Sinoatrial node –
⮚ primary pacemaker
Cardiac conduction system: ⮚ inherent firing rate (resting) =
generates and transmits electrical 60 – 100 bpm
impulses that stimulate contraction b. Atrioventricular node
of the myocardium ⮚ Secondary pacemaker
⮚ firing rate = 40 – 60 bpm

→SA node
→Internodal pathways
→AV node
→Contraction of atria
→Bundle of His
→RBB
→Purkinje cells (RV)
→LBB
→Purkinje cells (LV)

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3 physiologic characteristics of nodal

cells and Purkinje cells:
a. Automaticity – ability to initiate an
electrical impulse
b. Excitability – ability to respond to
an electrical impulse
c. Conductivity – ability to transmit
an electrical impulse from one
cell to another

CARDIAC ACTION POTENTIAL

❖Depolarization: electrical activation

of a cell caused by the influx of
sodium into the cell while potassium
exits the cell (electrical stimulation)
▪ Systole: mechanical contraction

❖Repolarization: return of the cell to ❖Sodium – rapidly enters cell (atrial &
resting state, caused by reentry of ventricular myocytes) through
potassium into the cell while sodium sodium fast channels
exits the cell
▪ Diastole: mechanical relaxation
❖Calcium – enters cell (cells of the
SA & AV node) through slow
❖Refractory period: period in which channels
cells are incapable of being stimulated
⮚Effective (absolute) refractory period
⮚Relative refractory period

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OBTAINING AN
Obtaining an ECG
ELECTROCARDIOGRAM
● ELECTROCARDIOGRAPHY – the study of
Electrodes are attached to cable wires, which
records of electrical activity generated by the
are connected to one of the following:
heart muscle
a. ECG machine – immediate recording
b. Cardiac monitor – continuous monitoring
● ECG
c. Telemetry – continuously transmits ECG
– a graphic representation of the electrical
information by radiowaves to a central
currents
monitor
- allows viewing of electrical conduction
d. Holter monitor – small, lightweight tape
- reflects waveform on screen/ paper which recorder-like machine that the pt wears
represents each phase of the cardiac cycle

ECG
MACHINE CARDIAC MONITORS

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HOLTER MONITOR

WHAT IS A LEAD?
> an imaginary line that serves as a reference
from which the electrical activity is viewed

STANDARD ECG : 12 LEADS

• Leads I, II, III
• Leads aVR, aVL, aVF
• Precordial Leads: V1, V2, V3, V4, V5, V6

Others: 15-Lead ECG, 18-Lead ECG

PLACEMENT OF ELECTRODES FOR A STANDARD

12-LEAD ECG Precordial Leads / Chest Leads
❑ 4 limb leads and 6 chest leads
a. Limb electrodes (4)
- provides 1st 6 leads: I, II, III, aVR, aVL, AVF

b. Chest electrodes (6)

V1 – 4th ICS, Right sternal border
V2 – 4th ICS Left sternal border
V3 – diagonally between V2 and V4
V4 – 5th ICS Left midclavicular line
V5 – same level as V4, anterior axillary line
V6 – same level as V4, V5, midaxillary line

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Limb leads

Ride
Your
Green
Bike

Nursing Considerations (ECG)

●Electrodes are placed on dry, non-
bony areas and in areas without
ECG Lead significant movement
Placement ●Connect electrodes to lead wires
before placing them on the chest
●Peel the backing off the electrode
●Check skin for irritation (changed q 24-
48 hrs)

Electrodes

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Don’t use adipose fats as landmarks

For a standard 12-lead ECG:
⮚6 chest leads,4 limb leads
⮚ECG waveforms are printed on graph
paper:
▪ Horizontal axis –time and rate
▪ Vertical axis – amplitude or voltage
⮚Positive deflection
⮚Negative deflection

The ECG paper

❑T w a v e – r e p r e s e n t s v e n t r i c u l a r
repolarization (simultaneous with atrial
⮚ECG waveforms, complexes: repolarization but is not visible because
❑P w a v e - r e p r e s e n t s a t r i a l it occurs at the same time as the QRS)
depolarization
• 2.55 mm in height ❑U w a v e – t h o u g h t t o r e p r e s e n t
• 0.11 sec in duration repolarization of Purkinje fibers
❑Q R S c o m p l e x – r e p r e s e n t s • Seen in pts with hypokalemia,
ventricular depolarization HPN, or heart disease
• Less than 0.12 sec in duration

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❑PR interval (from beginning of P wave to

the beginning of QRS complex)– the time
needed for sinus node stimulation, atrial ❑QT interval (beginning of QRS
depolarization, and conduction through complex to end of T wave) –
AV node before ventricular depolarization represents the total time for
• 0.12 – 0.20 sec in duration ventricular depolarization and
❑ST segment (from the QRS complex to repolarization
the beginning of T wave)– represents Ø0.32 – 0.40 sec in duration
early ventricular repolarization ØIf prolonged, pt may be at risk for
• Normally isoelectric (when it is above TORSADES DE POINTES (lethal)
or below the isoelectric line, a sign of
cardiac ischemia)

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Defibrillation

❖sinus rhythm: electrical activity

of the heart initiated by the SA Normal Sinus Rhythm
node

❖normal sinus rhythm – electrical

impulse starts at a regular rate
and rhythm in the SA node

CARDIAC
DYSRHYTHMIAS

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I. CARDIAC DYSRHYTHMIAS
Dysrhythmias: disorders of the formation
or conduction of the electrical impulse
within the heart, altering the heart rate,
heart rhythm, or both and potentially
causing altered blood flow.
ØLeads to decreased cardiac output
ØMost serious complication: SUDDEN
CARDIAC DEATH
ØNamed according to the site of origin of
the impulse and the mechanism of
formation or conduction involved

Food that triggers release of

Cathecholamines
Etiology
ü Coffee
ü Tea
●Increased ü Bananas
sympathetic ü Chocolate
stimulation – ü Cocoa
exercise, anxiety, ü Citrus fruits
fever, ü Vanilla
administration of ü Severe stress
catecholamines ü Acute anxiety

Regularity: R-R intervals are constant; How to compute for Heart rate using ECG
rhythm is regular results:
Rate: Atrial & ventricular rates are equal
; Normal (60-100 bpm)
P wave: Uniform; there’s 1 P wave in front of
Count the number of small circle from an R
every QRS complex to another R interval
Divide 1500 (Constant) the total number of
PR interval: 0.12 to 0.20 sec small circle.
QRS: less than 0.12 sec Example:
Number of small circles – 22
Constant – 1500

1500 / 22 = 68.18 bpm or 68 bpm

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TYPES OF DYSRHYTHMIAS
Types

A. Sinus Node Dysrhythmias SINUS NODE

• Sinus Bradycardia
• Sinus Tachycardia
DYSRHYTHMIAS
B. Atrial Dysrhythmias • Sinus Arrhythmia

C. Ventricular Dysrhythmias

TYPES OF SINUS NODE DYSRHYTHMIAS

A. Sinus Bradycardia (<60 bpm, regular rhythm)

Ø Parasympathetic nervous system (vagal

stimulation) causes automaticity of the SA node
to be depressed
Ø Causes: MI, Valsalva maneuver; or vomiting,
arteriosclerosis in the carotid area; ischemia of
SA node; hypothermia, hyperkalemia,
depression or medications (digitalis, propanolol)
Ø DOC: atropine sulfate 0.5 mg IV q 3-5 min. to a
max total dose of 3 mg

Number of small circles = 63

Constant factor = 1500

1500/63 = 23. 8 bpm or 24

bpm

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Normal sinus rhythm TYPES OF SINUS NODE DYSRHYTHMIAS

B. Sinus tachycardia (100-120 bpm,

regular rhythm)
▪ sinus node creates an impulse at
a faster-than-normal rate
▪ Causes: physiologic or
psychological stress, medications
that stimulate the sympathetic
response, autonomic dysfunction

Sinus Bradycardia

Rules for Sinus Tachycardia

Regularity: R-R intervals are constant; rhythm is regular
Rate: Atrial & ventricular rates are equal
; rate is greater than 100 bpm (usually between 100 Ø Number of small circles = 12
and 160 bpm) Ø Constant factor = 1500
P wave: Uniform; there’s 1 P wave in front of every QRS
complex
PR interval: 0.12 to 0.20 sec; Ø 1500/12 = 125 bpm
QRS: less than 0.12 sec

Normal sinus rhythm TYPES OF SINUS NODE DYSRHYTHMIAS

C. Sinus arrhythmia

▪ Normal HR but irregular rhythm

▪ sinus node creates an impulse at an irregular
rhythm
▪ Does not cause any significant hemodynamic
effect and usually is not treated
▪ Cause: Heart disease, valvular disease (rare)

Sinus Tachycardia

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Some causes of Arrhythmia

Normal sinus rhythm

Ø Smoking.
Ø Drinking too much alcohol or caffeine.
Ø Drug abuse
Ø Stress or anxiety.
Ø Certain medications and supplements,
including over-the-counter cold and
allergy drugs and nutritional
supplements.
Ø Genetics.
Sinus Arrhythmia

TYPES OF DYSRHYTHMIAS

ATRIAL DYSRHYTHMIAS

Atrial Fibrillation

Normal sinus rhythm

Premature Atrial Complex (PAC)

Ø< 6 PACs per minute – no
treatment necessary
Ø> 6 PACs per minute – indicate
worsening of disease and onset
of more serious dysrhythmias
ØTreatment: identify and treat the
cause
Premature Atrial Complex

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Normal sinus rhythm

Atrial Flutter

Treatment:
▪ unstable pt: electrical cardioversion ● Cardioversion is a medical
+ Anticoagulants procedure that restores a
▪ stable pt: Adenosine 6mg rapid IV normal heart rhythm in people
followed by a 20ml saline flush and with certain types of abnormal
elevation of arm with IV line + vagal heartbeats (arrhythmias).
maneuvers
▪ Medications that slow ventricular
response = BABA, CCB, Digitalis

C. Atrial Fibrillation (ventricular rate 120 –

Cardioversion 200bpm, highly irregular)
▪ Atrial rate: 300 – 600 bpm
▪ A rapid, disorganized, and uncoordinated
twitching of atrial musculature which
affects ventricular rate & rhythm as well

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Normal sinus rhythm

▪ Associated with: advanced age,
valvular heart disease, CAD, HPN,
heart failure, DM, hyperthyroidism,
congenital d/0 of the heart,
alcohol ingestion
• IMPORTANT CONSIDERATION:
High risk of STROKE & premature
death due to possible clot formation
2⁰ erratic atrial contraction

Atrial
Fibrillation

Atrial Fibrillation (AF)

●Many AF convert to normal sinus w/in
● S/S: some are asymptomatic but others 24 hours with treatment
have: ●(+) AF & hemodynamically unstable –
- irregular palpitations Cardioversion
- S/S of Atrial Fibrillation (SOB, fatigue,
exercise intolerance, malaise)
●Warfarin (Coumadin) - 4 weeks after
cardioversion
- hemodynamic collapse: hypotension,
chest pain, pulmonary edema, altered
LOC
- pulse deficit

● Meds: Amiodarone (Cordarone),

Flecainide (Tambocor), Solatol, Cont… Atrial Fibrillation
Propafenone (Rhythmol) – ●IV Calcium Channel Blockers
Administered before cardioversion;
(CCB)– decrease the HR;
may achieve the same effect as
cardioversion ○ C/I: bronchospasm, ventricular
failure
●IV Digoxin or Amiodarone
(Cordarone) – if CCB are C/I
●Anti-thrombotic therapy - Heparin

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A. Premature Ventricular Complex

(depends on underlying rhythm, irregular)
▪ An impulse that starts in a ventricle and
is conducted through the ventricles
before the next normal sinus impulse.
• Premature Ventricular
VENTRICULAR DYSRHYTHMIAS
Complex ▪ QRS shape: Bizarre & abnormal
• Ventricular
Tachycardia P wave: may be absent (hidden in QRS)
• Ventricular Fibrillation
• Idioventricular rhythm ▪ Usually not serious; can occur in healthy
• Ventricular Asystole people

Premature Ventricular
● Ventricular premature complexes occur
Complex (PVC) when the lower chambers of your heart
contract before they should. When this
happens, your heartbeat becomes out of sync.
You may feel a regular heartbeat, an extra
heartbeat, a pause, and then a stronger
heartbeat.

Causes of PVC:
✔ Cardiac ischemia or infarction Trigeminy
✔ Increase cardiac workload (Heart Failure)
✔ Digitalis toxicity
✔ Hypoxia, acidosis and hypokalemia
Types:
▪ Bigeminy – every other complex is a PVC Quadrigeminy
▪ Trigeminy – every third complex is a PVC
▪ Quadrigeminy – every fourth complex is a
PVC

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Watch out for ST elevation!

Management of PVC: (An Impending Heart Attack)
1. Notify physician
2. Identify the cause and treat (as
prescribed by the doctor)
3. Evaluate Se K+
4. O2 as prescribed
5. Lidocaine (Xylocaine) as prescribed
6. Notify : (+) chest pain, PVC which
increases in frequency

TYPES OF VENTRICULAR
DYSRHYTHMIAS
B. Ventricular Tachycardia (100 -200 bpm,
regular)
● Usually associated with CAD (Coronary
Artery Disease) and MI (Myocardial
Infarction), may precede Ventricular
fibrillation
● QRS shape: bizarre & abnormal
P wave: very difficult to detect

Cont… Ventricular Tachycardia

●Considered an EMERGENCY! : pt. is

usually unresponsive and pulseless  
cardiac arrest
Management:
●DOC (for unstable pts): Amiodarone IV/
Procainamide (MI w/ VT) + cardioversion
●For symptomatic patient: Cardioversion
●For unconscious, pulseless pts: immediate
defibrillation + CPR

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CPR (for 2 minutes)

Maintenance:
Emergency CODE in Rhythm check ICD (Implantable Cardioverter
the Hospital
Defibrillator) – for <35% EF;
If with pulse (+) If without pulse (-)
Monitor Heart rate Amiodarone for >35%
(ECG/Cardiac Monitor) epinephrine every 3
mins ● Ejection Fraction (EF)
○ Percentage of blood being pumped out
If Regular If Irregular

No Intervention VT, VF AF, AFib ❑Equal or less than 40% (DANGER)

❑41-49% (CAUTION)
❑50-70% (GOOD)
Monitoring Defibrillation Cardioversion
(pulseless/HB +) (with pulse)

Implantable Cardioverter
Defibrillator C. Ventricular Fibrillation (greater than 300 bpm,
extremely irregular)
▪ A rapid, disorganized ventricular rhythm that
causes ineffective quivering of the ventricles
characterized by absence of audible heartbeat, a
palpable pulse and respirations
▪ RAPIDLY FATAL & LIFE-THREATENING!  
cardiac death is IMMINENT if not treated w/in 3-5
min
▪ Causes: same as VT, electrical shock, and
Brugada syndrome (pt w/ a structurally normal
heart, few risk factors for CAD & family hx of
sudden cardiac death)

Management: (Vfib)
▪ Treatment of choice: bystander CPR till
defribrillation is available + activation of
emergency services
▪ Unwitnessed arrest + 4 mins delay in emergency
services = 5 cycles CPR   defibrillation  
additional 5 cycles CPR beginning w/ chest
compression & alternate w/ rhythm check and
defibrillation

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Emergency CODE in the Hospital CPR (for 2 minutes)

Rhythm check
▪ epinephrine (Adrenaline) – given after the 2nd rhythm
check (immediately before or after 2nd defib) then every
3-5 min If with pulse (+) If without pulse (-)
Monitor Heart rate
▪ Other anti-arrhythmic meds: Amiodarone & Lidocaine – (ECG/Cardiac Monitor) epinephrine every 3 mins
given ASAP after 3rd rhythm check (immediately before
or after 3rd defib) If Regular If Irregular

No Intervention VT, VF AF, AFib

Monitoring Defibrillation Cardioversion

(pulseless/HB +) (with pulse)

QUESTION!!!
E. Ventricular Asystole (flatline)
How many seconds do we ▪ Absent QRS complexes in 2 different
perform rhythm check? leads
▪ No heartbeat, no palpable pulse, no
respiration
Answer ; 10 seconds

Cont Mgt… Ventricular Asystole

●Establish IV access (done with NO or
Management:
MINIMAL interruptions in chest
▪ Treatment: high-quality CPR with compression)
minimal interruptions
●After 2 min or 5 cycles of CPR   Bolus IV
▪ Identify and treat underlying
Epinephrine administered & repeated
cause
every 3-5 min interval
▪ intubation
●Bolus IV Atropine may be given after
rhythm check
●If (-) response: “Code is called” or efforts
are ended

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MEDICAL MANAGEMENT:
CARDIAC DYSRHYTHMIAS A. Antiarrhythmic medications:
a. I – Na+ Channel Blockers
Complications ▪ Quinidine (Quinidex)
▪ Cardiac arrest ▪ Procainamide (Procar S)
▪ Heart failure ▪ Lidocaine (Xylocaine)
▪ Thromboembolic event (esp. with b. II – Beta-Adrenergic Blocking Agents (BABAs)
atrial fibrillation) ▪ Atenolol (Tenormin)

B. VAGAL MANEUVERS
Ø induce vagal stimulation of the cardiac conduction system;
used to terminate supraventricular tachydysrhythmias
1. Carotid Massage
c. III – K= Channel Blockers ü Physician instructs client to turn the head away from the
▪ Amiodarone (Cordarone) side to be massaged
IV – Ca+ Channel Blockers ü The carotid artery is massaged for 6-8 sec until there is a
change in the cardiac rhythm
▪ Verapamil (Isoptin)
▪ Diltiazem (Cardizem)

2. Valsalva maneuver
ü Observe cardiac monitor üPhysician instructs client to bear down or
ü Record an ECG rhythm strip before, during & after the induce a gag reflex in the client, both of
procedure which stimulate the vagal reflex
ü Have a defibrillator & rescusitative equipment available üMonitor HR, rhythm & BP
ü Monitor VS, cardiac rhythm & LOC after the procedure üObserve the cardiac monitor

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üRecord an ECG rhythm strip before, during & after C. Cardioversion: electrical current administered
the procedure in synchrony with the pt’s own QRS complex to
stop a dysrhythmia
üHave a defibrillator & rescusitative equipment
available Ø An elective procedure done by the physician
üProvide an emesis basin if the gag reflex is Ø A lower amount of energy is used than with
defibrillation
stimulated, and initiate precautions to prevent
aspiration

Ø Cardioversion is synchronized to the client’s R

wave to avoid discharging the shock during the
vulnerable period (T wave)
Ø If the cardioverter were not synchronized, it would
discharge on the T wave and cause VF

Cont… Cardioversion Cont… Cardioversion

Implementation:
Post-procedure;
Pre-procedure:
ü Maintain airway patency
✔ Obtain consent
✔ Administer sedation as prescribed
ü Administer O2 as prescribed
✔ Hold Digoxin (Lanoxin) 48 hours preprocedure to ü Assess VS
prevent post-cardioversion ventricular irritability ü Assess LOC
During: ü Monitor for cardiac rhythm
Ensure that the skin is clean & dry in the area where ü Monitor for indications of successful
the electrode paddles will be placed response: conversion to sinus rhythm,
Stop the O2 during the procedure to avoid hazard of strong peripheral pulses and an
fire
adequate BP
Be sure that no one is touching the bed or the client
when delivering the countershock

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C. Defibrillation
Ø electrical current administered to stop a dysrhythmia,
not synchronized with the pt’s QRS complex
Ø 3 rapid consecutive shocks are delivered with the
first at an energy of 200 joules
Ø If unsuccessful, the shock is repeated to 200-300
joules
Ø 3rd: 360 joules

✔Use of paddle electrodes:

• Apply conductive pads
IMPLEMENTATION:
• One paddle: 3rd ICS R
✔Stop the O2 during the procedure to of sternum
avoid hazard of fire The other paddle: 5th
✔Be sure that no one is touching the bed ICS L midaxillary line
or the client when delivering the • Apply firm pressure
with the paddles
countershock • Be sure that no one is
touching the bed or the
patient when delivering
the countershock

D. AUTOMATIC EXTERNAL DEFIBRILLATOR

(AED)
▪ Used by laypersons and emergency medical
technicians to pre-hospital cardiac arrest
✔ Place the client on a firm, dry surface
✔ Stop CPR
✔ Ensure that no one is touching the client, to
avoid motion artifact during rhythm analysis

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✔Place the electrode paddles in the correct position

on the client’s chest
✔Press the analyser button to identify the rhythm,
which may take 20 sec; the machine will advise if
shock is necessary
✔Shocks are recommended for pulseless Ventricular
Fibrillation only

CARDIAC DYSRHYTHMIAS
pacemaker
Ø Pacemaker Therapy: an electronic
device that provides electrical stimuli
to the heart muscle; may be
temporary or permanent

Ø Implantable Cardioverter
Defibrillator: a device that detects
and terminates life-threatening
episodes of tachycardia or fibrillation

CARDIAC DYSRHYTHMIAS

NURSING MANAGEMENT II. Diagnoses

I. Assessment ØDecreased cardiac output
Ø Possible causes of the dysrhythmia and ØAnxiety related to fear of the
contributing factors unknown
Ø Effects on the heart’s ability to pump ØDeficient knowledge about the
Ø History dysrhythmia and its treatment
Ø Psychosocial assessment
Ø Physical assessment

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CARDIAC DYSRHYTHMIAS CARDIAC DYSRHYTHMIAS

III. Planning IV. Interventions

✔ Eliminate or decrease occurrence 1. Monitoring and managing
of dysrhythmia to maintain cardiac the dysrhythmia
output ✔ Administer
✔ Minimize anxiety antiarrhythmic
✔ Acquire knowledge about medications
dysrhythmia and its treatment ✔ Administer a 6-minute
walk test

2. Minimizing anxiety CARDIAC DYSRHYTHMIAS

✔Maintain a calm, reassuring attitude
✔Emphasize successes in treatment to 3. Promoting home and community-based care
the pt ✔ Importance of maintaining therapeutic
✔Help pt develop a system to identify serum levels of antiarhythmics
possible causative, influencing, and
alleviating factors
Therapeutic levels of digoxin are
0.8-2.0 ng/mL.
The toxic level is >2.4 ng/mL.

CARDIAC
DYSRHYTHMIAS
✔Establish a plan of action to take V. Evaluation
in case of emergency ⮚Maintains cardiac output
✔ Teach about potential effects of ⮚Experiences reduced anxiety
the dysrhythmia and their s/s ⮚Expresses understanding of the
dysrhythmia and its treatment

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TYPES OF JUNCTIONAL DYSRHYTHMIAS

TYPES OF DYSRHYTHMIAS
A. Premature Junctional Complex
▪ An impulse that starts in the AV nodal
area before the next normal sinus
impulse reaches the AV node
• Premature Junctional
Complex ▪ Causes: digitalis toxicity, heart failure,
• Junctional rhythm CAD
JUNCTIONAL
DYSRHYTHMIAS • Nonparoxysmal Junctional
Tachycardia
• Atrioventricular Nodal
Reentry Tachycardia

TYPES OF JUNCTIONAL DYSRHYTHMIAS

B. Junctional rhythm (40 -60 bpm, C. Nonparoxysmal Junctional Tachycardia

▪ Caused by enhanced automaticity in the
regular)
junctional area
▪ Occurs when the AV node, ▪ May indicate a serious underlying condition
instead of the sinus node, ▪ Cardioversion is not an effective treatment
becomes the pacemaker of the
heart

TYPES OF JUNCTIONAL DYSRHYTHMIAS

D. Atrioventricular Nodal Reentry Tachycardia

(75 -250 bpm, regular)
● an impulse is conducted to an area in the AV
node that causes the impulse to be rerouted
into the same area over and over again at a
very fast rate

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TYPES OF VENTRICULAR DYSRHYTHMIAS

●If P waves cannot be identified: D. Idioventricular rhythm (20 – 40

Supraventricular Tachycardia bpm, regular)
(SVT) ▪ Occurs when the impulse starts in
the conduction system below the
AV node

●Treatment – vagal maneuvers and

adenosine

TYPES OF DYSRHYTHMIAS

• First-Degree Atrioventricular
Block
• Second-Degree Atrioventricular
CONDUCTION Block, Type 1
ABNORMALITIES • Second-Degree Atrioventricular
Block, Type 2
• Third-Degree Atrioventricular
Block (Complete block)

TYPES OF CONDUCTION ABNORMALITIES

A. First-Degree Atrioventricular
Block
▪ Occurs when all the atrial
impulses are conducted through
the AV node into the ventricles at
a rate slower than normal

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● First-degree
atrioventricular (AV) block is
defined as a PR interval of
greater than 0.20 seconds on
electrocardiography (ECG)
without disruption of atrial to
ventricular conduction.

● The normal measurement of the

PR interval is 0.12 seconds to
0.20 seconds.

B. Second-Degree Atrioventricular Block, C. Second-Degree Atrioventricular Block,

Type 1 Type 2
▪ Occurs when there is a repeating pattern in
▪ Occurs when only some of the atrial
which all but one of a series of atrial impulses
are conducted through the AV node into the impulses are conducted through the
ventricles AV node into the ventricles

TYPES OF CONDUCTION ABNORMALITIES

D. Third-Degree Atrioventricular
Block (Complete block)
▪ Occurs when no atrial impulse is
conducted through the AV node
into the ventricles

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