内科学教学课件：Cardiac Arrhythmia.pptVIP

CONDUCTION DISTURBANCES Abnormalities of conduction can occur between the sinus node and atrium , within the atrioventricular node , and in the intraventricular conduction pathways . Atrioventricular Block Causes: First-degree and mobitz type Ⅰblock may occur in normal individuals with heightened vagal tone. They may also occur as a drug effect (especially digitalis,calcium channel blockers, β-blockers, or other sympatholytic agents). These disturbances also occur transiently due to ischemia, infarction, inflammatory processes. The prognosis is usually good. Causes: Mobitz type Ⅱ block and complete (third-degree) heart block is almost always due to organic disease involving the infranodal conduction system(acute myocardial infarction, coronary spasm, carditis, hypertention, electrolyte abnormalities) Cinical manifestation: Patients with first-degree block may be asymptomatic . Patients with Second-degree block may feel palpitations ,. Complete (third-degree) heart block may cause weakness, dizziness , heart failure , angina or syncope , Adams-Strokes syndrome. ECG: First-degree AVB: PR interval 0.20 second with all atrial impulses conducted. Second-degree (Mobitz type Ⅰ): the atrioventricular conduction time(PR interval) progressively lengthens ,with the RR interval shortening, before the blocked beat; Mobitz type Ⅱ atrioventricular block there are intermittently nonconducted atrial beats not preceded by lengthening atrioventricular conduction. Third-degree heart block: shows P wave and the R waves are independent from each other , P wave and the R waves are regular , but no supraventricular impulses are conducted to the ventricles. Manifestation of Third degree AVB On auscultation, intensity of S1 varies due to loss of AV synchrony, cannon sound(wave), S3，S4 can be heard Syncope, presyncope, chest compression heart failure, etc. are seen frequently. With high risk of sudden death Treatment: First-degree AVB and Second-degree (Mo