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HEART PHYSIOLOGY

(ARRYTHMIAS)
BY
DR. MUDASSAR ALI ROOMI (MBBS, M. PHIL)
Assistant Professor Physiology

SA NODAL HEART BLOCK:
impulse from SA node is blocked
before it enters the atria
Results in standstill of atria
the ventricles pick up a new
rhythm, the impulse usually
originating spontaneously in the
AV node.
that the rate of the ventricular
QRS-T complex is slowed but not
otherwise altered.
Cause: Strong vagal stimulation
Treatment: can be relieved by
giving atropine (anticholinergic
drug).

AV BLOCK
conduction of impulses from the
atria to ventricles is either slowed
down or completely blocked and
the block is in AV node or in AV
bundle.
Causes of AV block:
Ischemia
compression of conductive tissue
by a scarred or fibrosed portion of
myocardium.
Inflammation of AV node or AV
bundle: Diphtheria, rheumatic
fever and myocarditis
Strong vagal stimulation.
AV block is of two types:
1. Incomplete (partial) AV Block:
First degree AV block
Second degree AV block
2. Complete (3
rd
degree) AV block:


First degree AV block

All impulses are
conducted from atria to
ventricles but there is
prolonged PR interval
i.e. > 0.20 sec
Usually because of
ischemia
Treatment: Usually no
need to do any
intervention
H
SA Node
AV Node
Delay
Prolonged
P-R Interval
Prolonged
P-R Interval
First Degree Heart Block
Copyright 2006 by Elsevier, Inc.
Second degree AV
block

MOBITZ TYPE I 2
ND
DEGREE AV
BLOCK:
also called Wenckebach
phenomenon.
There is progressive prolongation
of PR interval in successive heart
beats, till a heart beat is dropped.
MOBITZ TYPE II 2
ND
DEGREE AV
BLOCK:
PR interval is permanently or
constantly prolonged.
PR interval may be> 0.45 sec
There is 2:1 rhythm or 3:1 rhythm
i.e. every 2
nd
or 3
rd
impulse from
atria is conducted to ventricles.
In ECG we find that after every 2 or
3 P waves there is one QRS
complex.


MOBITZ II HEART BLOCK
Intermittent Block
H
SA Node
AV Node
Second Degree Heart Block
Conducted
Blocked
Conducted
Blocked
Copyright 2006 by Elsevier, Inc.

Complete (Third Degree) AV
block

conduction of impulses from Atria
to ventricles is completely
blocked.
Ventricles start their own rhythm
at a slower rate.
So, atria beat independently with
the SA nodal rhythm (70-80 bpm)
and ventricles beat with their
own rhythm (15-40 bpm).
Complete dissociation b/w atria
and ventricles ***
In ECG there is no association
between P wave and QRS
complex.
Treatment: atropine, pacemaker
STOKES-ADAMS SYNDROME
Refers to sudden transient
episode of syncope due to 3
rd

degree heart block
Ventricle stops contracting for 5-
30 seconds due to override
suppression
After some time ventricles pick
up their own rhythm (15-40
bpm)= ventricular escape
Clinical features: bradycardia,
Cannon a waves visible in the
jugular veins, Unconsciousness
(syncope)
3
rd
degree AV nodal block comes
and goes with variable interval in
b/w.

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