i bc27f85be50b71b1 (34 page)

Table I·A.4. Electroc3rdlographic {EeGl Characteristics 3nd Causes of Arnovenrricul3r Blocks

N3me

ECG ChJracrcristics

Common Causes

PT Considerations

brst-degree AV block

Regular rhythm, rate nor·

Elderly wirh heart disease,

If chronic, need ro be more cmmous

mal 60- 100, prolonged

acute myocarditis, acute �1I

of underlying he3rt disease; if new

PR Interval >0.2 (con·

onset, mOOltOr c1osel)· for pro·

stant).

gression to higher level block.

Second-degree AV block

Irregular rhythm, arrial rare

Acute infection, acme �tI

Symproms are uncommon, as

type I (Wenkebach,

> ventricular rate, usu311y

above.

Mobltz I)

both 60-100; PR Interval

lengthens until P W3ve

appears without 3 QRS

complex.

Second-degree AV block

Irregular rhythm, aerial rate

Anterosepral MI

CHF IS commonj can have dizzl·

type II (Mobitz II)

> ventricular nne, PR

ness, fainting, complete uneon·

('

>-

interval may be normal or

sciousnessj may need pacing

'"

prolonged bur is consr3nr

;;

and PT treatmem; should he


for each conducted QRS.

held for medical management.


Third-degree AV block

Regular rhythm, arrial rare >

Ameroseprai MI, drug imoxi·

Severe CHFj patient will need med·

§

(complete heart

ventricular rarc.

c3rion, infections, electro·

ical management; a pacer (rem·

;:

block)

lyre imbal3nces, coronary

porary or permanent depending

>


artery disease, degenerative

on reversihiliry of eriolob'Y) is


sclerotic process of AV can·

almosr always necessary.

"

x

duction system

AV = amoventricubr; ClIF = congestive heart failure; MI = myocardial infarction.

Sources: Data from B Aehlen. ACLS Quick Review Study Guide. St. Louis: Mosby, 1 994; and EK Chung. Manual of Cardiac Arrhythmias. 80s·

....

'D

tOn: Bunerwonh-Heinemann, 1 986.

Appendix 1 -B

82 AClfrE CARE HANDBOOK FOR PHYSICAL THERAPISTS

Figure 1-8.1. Paroxysmal supraventricular tachycardia. Note development

from 110rmal sinus rhythm. (\Vith permission from M \'(/alsh, A Crumbie, S

Reveley. Nurse Practitioners: Clinical Skills and Professional lssucs. Boston:

Butterworth-HeiNematm, J 993;96.)

Figure 1-8.2. Atrial {lutter. Note regular rhythm (P waves) but vemriwfar

rhythm depends on CONduction pattern. (\Vith permission fr011l M \Valsh, A

Cmmbie, S RevelC),. Nurse PractitioNers: Clinical Skills and Professional

Issues. Boston: Butterworth-Heinemann, 1 993;95.}

CARDIAC SYSTEM I\PPENDIX ] -B

83

Figure I-B.3. Atrial fibrillation. Note the irregular rhythm alld absence of

normal P waves. (With permission from M Wafsh, A Crumbie, S Reveley.

Nurse Practitioners: Clinical Skills and Pro(essional Issues. Boston: Butterworth-Heinemann, 1 993;95.)

Figure 1-8.4. Ventricular tachycardia. Rate 100-170 beats per minute. No P

waves, broad electrocardiographic wave complexes. (Reprillted with pemlission (rom M Walsh, A Crumbie, S Reveley. Nurse Practitioners: Clinical Skills and 1)ro(essiollal ls5ues. BOSIOI1: Butterworth-Heinemann, 1 993;98.)

84

AClITE CARE HANDBOOK fOR I'HYSICAL THERAI'IS1S

p

p

p

Figure I-B.S. Ventricular ectopy with refractory period afterward. (\Vith permissioN from M \Valsh, A Crumbie, S Reveley. Nurse Praclltioners: Clinical Skills and Professional Issues. Boston: Butterworth-Hememallll, 1 993;97.)

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