Heart block

ECG Hour

Olivia Faye J Listanco

2nd Year IM Resident

Heart Blocks: Bundle

branch

INTERRUPTION IN THE ELECTRICAL

CONDUCTION SYSTEM OF EITHER THE
RIGHT, LEFT OR BOTH BUNDLE
BRANCHES.
CAUSES A DELAY TO THE VENTRICLES.
THE INTERRUPTION FORCES THE
IMPULSE TO DETOUR AND TAKE
ANOTHER ROUTE TO THE VENTRICLES.

Right Bundle Branch

Block

RBB has ONE

FASCICLE
When block
occurs, the
depolarization in
the RBB is
DELAYED

Right Bundle Branch Block

Right Bundle Branch Block

QRS
> 0.12 seconds
complex
S wave
Wide in lead I, wide
and slurred in V5 to V6
rsR
V1 and V2
Secondary ST-and-Twave changes in V1
and V2

Left Bundle Branch

Block

N septal
depolarisation is
reversed (RL),
Iimpulse spreads
first to the RV via
theright bundle
branchand then
to the LV via the
septum

Right Bundle Branch Block

Criteria
QRS
> 0.12 seconds
complex
R wave Broad monophasic R
wave in lead 1, V5,
and V6
No Q waves in V5
and V6

Left Ant Hemiblock

Left Ant Hemiblock

Axis
LAD (-30 to -90)
QRS
<120 sec
R wave qR pattern in AvL
Time to peak R in
aVL >45ms

Left Post Hemiblock

Left Post Hemiblock

Axis

RAD (+90 - +180)

QRS

<120 sec

R wave qR pattern in lead I and

aVL with qR patterns in
leads III ad avF
Time to peak R in aVL
>45ms

Heart conduction: AV
Blocks

OCCUR WHEN THERE IS A PARTIAL OR

COMPLETE INTERRUPTION IN THE
CARDIAC ELECTRICAL CONDUCTION
SYSTEM.
CAN OCCUR ANYWHERE IN THE ATRIA
BETWEEN THE SA NODE AND THE AV
JUNCTION.
IN THE VENTRICLES BETWEEN THE AV
JUNCTION AND PURKINJE FIBERS.

THE APPEARANCE OF THE P WAVE AND

QRS COMPLEX VARIES, DEPENDING ON
THE TYPE OF HEART BLOCK.
RATE AND RHYTHM MAY VARY.
LOCATION OF THE BLOCK AND PATIENT
SYMPTOMS
DETERMINE IF THE DYSRHYTHMIA IS
LETHAL.

Normal
Rhythm
Rate
P wave
PR
QRS

Sinus Rhythm
Regular
60 100
Normal in configuration;
precede each QRS
Normal ( 0. 12 0.20
seconds )
Normal ( less than 0.12
seconds )

First-degree AV block
Rhythm Regular
Rate
Usually normal
P wave Sinus P wave present; one P
wave to each QRS
PR
Prolonged (greater than 0.20 seconds
)

QRS

Normal

Second -degree AV block, Mobitz I

Rhythm Irregular
Rate
Usually slow but can be
normal
P wave Sinus P wave present; some
not followed by QRS
complexes
PR
Progressively lengthens
QRS
Normal

Second-degree AV block, Mobitz II

Rhyth
m
Rate
P wave
PR
QRS

Regular usually; can be irreguler if

conduction ratios vary
Usually slow
Two, three, or four P waves before each
QRS
PR interval of beat with QRS is constant;
PR interval may be normal or prolonged
Normal if block in His bundle, wide if
block involves bundle branches

Third-degree AV block
Rhythm

Regular

Rate

40 60 if block in His bundle;

30 40 if block involves bundle branches

P wave

Sinus P wave present; bear no

relationship to QRS;

PR
QRS

Varies greatly
Normal if block in His bundle; wide if
block involves bundle branches

Mobitz

Mobitz II atrioventricular block

Atrioventricular dissociation secondary to complete heart block

High-grade atrioventricular

AF in RVR, RBBB, LAHB

Atrial flutter with LBBB

RBBB

LBBB

Thank you