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Response to carotid sinus massage: AV block worsens if the block is Wenkebach (block level is intranodal).
Response to exercise: The conduction ratio increases (block improves) if the block is Wenkebach (intranodal). Wide QRS complexes and increased PR interval (of the conducted P waves) suggest Mobitz Type 2 block. Heart block, also known as atrioventricular (AV) conduction system block, refers to decreased conduction of electrical impulses through the AV node. In order to understand the different types of heart block you have to first understand ECGs. Finally, type 3 AV nodal block occurs when the atria and ventricles beat independently of one other. Type 3 heart block = atria (p-waves) and ventricles (QRS) beat independently of each other; no impulses from the atria make it to the ventricles (image below). Mobitz type 1 (ie: one of the 2 subgroups of type 2 heart block) also generally requires no treatment.


Heart block (aka: atrioventricular block) occurs when impulses travel too slowly, or not at all through the AV node.
In Mobitz type 1 the amount of delay between the P-wave and QRS complex (ie: the PR interval) gradually increases until a beat is dropped.
The most common causes of 3rd degree block are severe diseases of the AV nodal system due to age, previous heart attack, drug and medication toxicity (ie: digitalis), and untreated Lyme disease. Patients with type 1 block rarely become symptomatic because the atria are still setting the pace of the entire hearts rhythm.
The reason is that the ventricles often beat at a rate that is too slow for normal daily activity.
A pacemaker will keep the heart beating at a pre-defined rate to ensure that symptoms do not develop. Mobitz type 2 occurs when the PR interval remains stable, and then out of the blue a missed beat occurs; this is caused most commonly by slowed conduction through the bundle of His or bundle branches. When this occurs symptoms such as syncope (ie: fainting), extreme fatigue, shortness of breath, and dizziness can occur.


The only instance where type 1 block may need further work up is in elderly patients who have other signs or symptoms of coronary artery disease. In these patients, pacemakers are often inserted to ensure that the heart beats at a pre-defined and safe rate. In type 2 missed beats can occur, and in type 3 the atria beat independently of the ventricles indicating complete conduction block. The QRS complexes may be narrow or wide depending on where in the conduction system the escape rhythm originates. These symptoms occur because the heart is not pumping blood fast enough to keep up with the body's demand; the result is a decrease in cardiac output.
Symptoms depend on the severity of block but can include fainting, shortness of breath, dizziness, and fatigue.



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