Mobitz type 2 av block ecg normal,m km hm dam,diabetes free by dr david pearson youtube - Videos Download

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. SA Wenckebach with a ladder diagram to show the progressive conduction delay between SA node and the atria.
PP intervals fairly constant (unless sinus arrhythmia present) until conduction failure occurs.
The diagram below illustrates the difference between Type I (or Wenckebach) and Type II AV block. In "classic" Type I (Wenckebach) AV block the PR interval gets longer (by shorter increments) until a nonconducted P wave occurs.
Type II AV block is almost always located in the bundle branches, which means that the QRS duration is wide indicating complete block of one bundle; the nonconducted P wave is blocked in the other bundle.
Usually see complete AV dissociation because the atria and ventricles are each controlled by separate pacemakers.


Narrow QRS rhythm suggests a junctional escape focus for the ventricles with block above the pacemaker focus, usually in the AV node. R or R' forces the ST-T should be negative or downwards; in leads with terminal S forces the ST-T should be positive or upwards. R or R' forces the ST-T should be downwards; in leads with terminal S forces the ST-T should be upwards.
Delta waves, if negative in polarity, may mimic infarct Q waves and result in false positive diagnosis of myocardial infarction. The greatest increase in PR interval duration is typically between the first and second beats of the cycle.
Malfunctioning AV node cells tend to progressively fatigue until they fail to conduct an impulse.
Mobitz I is usually a benign rhythm, causing minimal haemodynamic disturbance and with low risk of progression to third degree heart block. The Wenckebach pattern here is repeating in cycles of 5 P waves to 4 QRS complexes (5:4 conduction ratio). However, there is a single 3:2 Wenckebach cycle visible in the middle of the rhythm strip (QRS complexes 5 + 6).


Continuous rhythm strip recording revealed that this patient was indeed in Mobitz I AV block. The interval between the pacing spikes increases progressively until there is a non-conducted pacing spike.
Furthermore, the differentiation is electrocardiographically interesting but not clinically important. This is different to cells of the His-Purkinje system which tend to fail suddenly and unexpectedly (i.e. However, the difference is more obvious if you compare the first PR interval in the cycle to the last. If you look hard, you can see a non-conducted P wave deforming the downslope of the T wave in complex 6.
Our Team, headed by Mike Cadogan & Chris Nickson, consists (mostly) of emergency physicians and intensivists based in Australia and New Zealand.



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