heartblock.pptx adult health nursing ppt

health

1. H E A R T B L O C K

2. Normal conduction pathway: SA node -> atrial muscle -> AV node -> bundle of His -> Left and Right Bundle Branches -> Ventricular muscle

3. D EF I N ITI O N Heart block is an abnormal heart rhythm where the heart beats too slowly (bradycardia). In this condition, the electrical signals that tell the heart to contract are partially or totally blocked between the upper chambers (atria) and the lower chambers (ventricles).

4. T Y P E S They are further classified as, First degree heart block ( first degree AV block) second degree heart block (second degree AV block) third degree heart block (third degree AV block)

5. FIRST DEGREE HEART BLOCK First - degree atrio-ventricular block ( AV block ), or PR prolongation, is a disease of the electrical conduction system of the heart in which the PR interval is lengthened beyond 0.20 seconds.

6. The following are the most common causes of first- degree AV block: Intrinsic AVN disease Acute myocardial infarction (MI), particularly acute inferior wall MI Myocarditis Electrolyte disturbances (eg, hypokalemia , hypomagnesemia) Drugs (especially those drugs that increase the refractory time of the AVN, thereby slowing conduction)

7. First Degree Heart Block (1º) SA Node – normal Normal P wave AV Node conducts more slowly than normal Prolonged PR Interval Rest of conduction is normal Normal QRS

8. Significance Clinical significance None Treatment None Note – this can progress to 2º or 3º heart block

9. Second Degree Heart Block (2 º) Mobitz Type I (Wenkebach) Mobitz Type II

10. Second Degree Heart Block (2º) Mob i t z T y p e I (Wenkebach) Conduction through the AV Node – progressively delayed until a drop beat is seen

11. Second-degree atrio-ventricular (AV) block, or second-degree heart block, is characterized by disturbance, delay, or interruption of atrial impulse conduction through the AV node to the ventricles.

12. C A US E S Drugs (beta-blockers, calcium channel blockers, amiodarone) Cardiomyopathy rheumatic fever, myocarditis varicella-zoster virus infection Rheumatic diseases Hypoxia Hyperkalemia Hypothyroidism inferior wall myocardial infarction

13. Second Degree Heart Block (2º) Mob i t z T y p e I (Wenkebach) PR Interval prolongs with each beat until a dropped beat is seen The PR Interval is NOT constant After each dropped beat, the PR interval is normal and the cycle starts again

14. Second Degree Heart Block (2º) Mob i t z T y p e I (Wenkebach) PR PR PR DROPPED BEAT

15. Significance Clinical Significance Slight symptoms e.g.. Lethargy, Confusion Treatment Pacemaker if during day &/or symptoms No treatment if at night Note – this can progress to 3º Heart Block

16. S e co n d Deg r e e He a r t B l oc k ( 2 º) Mo b i t z T y p e I I Conduction through the AV node is constant. PR interval is normal and constant Occasionally a dropped beat is seen

17. S e co n d Deg r e e He a r t B l oc k ( 2 º) M o b i t z T yp e I I P R P R D R O P P E D B E A T P R

18. Significance Clinical significance – this is more significant disease Treatment – pacemaker Note – this can progress to 3º Heart Block

19. Third Degree Heart Block (3º) (Complete) Complete failure of the AV Node No impulses from Sinus Node will pass through to the ventricles Some part if the conducting system will take over as pacemaker of the heart (even a myocardial cell 10-15 bpm)

20. Third-degree atrioventricular (AV) block, also referred to as third-degree heart block or complete heart block , is a disorder of the cardiac conduction system where there is no conduction through the atrioventricular node.

21. Third Degree Heart Block (3º) (Complete) P wave rate – normal Ventricular rate – slow Ventricular complex may be broad Idioventricular rhythm Complete dissociation between P waves & QRS

22. T h i r d D eg r e e He ar t B l o c k (3º) (Complete) P P P P P Q R S Q R S

23. Significance clinical significance Symptoms LOC, Confusion, Dizziness, Low BP Can lead to standstill, VT or VF (stokes Adams) Treatment - pacemaker

24. Sign and symptoms Second-degree heart block symptoms: Fainting, feeling dizzy. Chest pain. Feeling tired. Shortness of breath. Heart palpitations.

25. Rapid breathing. Nausea. Third-degree heart block symptoms: Dizziness, fainting. Chest pain. Feeling tired. Shortness of breath.

26. Health care provider might recommend a  tilt table test  to evaluate repeated, unexplained episodes of lightheadedness, dizziness or fainting.

27. NURSING MANAGEMENT Assess the high risk patients Monitor ECG of the patient Assess the family history of heart disease Assess the history of smoking and alcoholism Monitor lab values frequently especially serum cholesterol levels. Assess for CAD Monitor vital signs Instruct to avoid high fat and oil rich diet

28. Nursing Management Monitor vital signs Place the patient on a cardiac monitor Obtain an ECG Assess oxygenation Check labs to ensure electrolytes are within normal limits Place the patient at bed rest Listen to the heart for murmurs Monitor for fluid retention Weigh patient

29. Hold medications that can disrupt cardiac rhythm (usually beta-blockers and antiarrhythmics) If the patient is to have a pacemaker, educate the patient Keep patient NPO Call the pacemaker nurse after the pacemaker has been inserted Educate patient about pacemakers, microwaves and TSA security checks which can cause magnetic interference with the pacemaker After surgery, educate the patient to keep the arm still and avoid strenuous activity Ask the patient to wear a medical alert bracelet Tell the patient to inform the cardiologist before undergoing any type of procedure or surgery