CMC COMPENDIUM
  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction

Cardiology Corner - Dr. L. Littmann

8/24/2017

0 Comments

 
Picture
I. Bifascicular Block and Second Degree AV Block
  1. In asymptomatic individuals, chronic bifascicular block in itself does not usually require cardiac work-up; the prognosis is generally benign
  2. The following high-risk features, however, warrant urgent evaluation:
  • Bifascicular block and syncope
  • Bifascicular block and intermittent second degree AV block
  • 1:1 AV conduction at slower sinus rates but higher grade block (i.e., 2:1 AV block) at faster sinus rates (“acceleration-dependent AV block”)
     3. Your role in the evaluation and management of patients with bifascicular block:
  • Actively search for nonconducted P waves in the 12-lead ECG
  • Also search for nonconducted P waves (second-degree AV block) in telemetry strips
  • In patients with bifascicular block who develop acceleration-dependent AV block with a very slow ventricular rate, carotid massage or IV beta blocker, by decreasing the sinus rate, can paradoxically restore 1:1 AV conduction; IV atropine, on the other hand, can increase the degree of block
  • Patients with bifascicular block and syncope require admission and cardiology consultation for possible pacemaker implantation
  • Patients with bifascicular block with intermittent second degree AV block require admission and cardiology consultation for possible pacemaker implantation

II. Second Degree AV Block with Narrow QRS complexes
           · The block is located within the AV node or the His bundle
           · The vast majority is in the AV node and is usually benign
           · Type I AV block (Wenckebach periodicity) confirms AV nodal block
           · Even if the AV block appears to be type II, it is most likely localized within the AV node and is usually benign (“pseudo-type II AV block”)
  • Confirm pseudo-type II block by demonstrating that the block occurred simultaneously with an abrupt deceleration of the sinus rate
  • Pseudo-type II AV block occurs in autonomic dysfunction, sleep apnea, obesity-hypoventilation, coughing spells, suctioning, vomiting etc.
          · 1:1 conduction at slower sinus rates but 2:1 block at faster atrial rates (i.e., acceleration-dependent block) strongly suggests the block to be at the level of the His bundle rather than the AV node
  • Implantation of a permanent pacemaker is usually indicated
 


0 Comments

Your comment will be posted after it is approved.


Leave a Reply.

    Archives

    August 2018
    February 2018
    January 2018
    December 2017
    October 2017
    September 2017
    August 2017
    July 2017
    June 2017
    May 2017
    April 2017
    March 2017
    February 2017
    January 2017
    December 2016
    November 2016
    October 2016
    September 2016
    August 2016
    July 2016
    June 2016
    May 2016
    April 2016
    March 2016
    February 2016
    January 2016
    December 2015
    November 2015
    October 2015
    September 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    February 2015
    January 2015
    December 2014
    November 2014
    October 2014
    September 2014
    August 2014
    July 2014
    June 2014
    May 2014
    April 2014
    March 2014
    February 2014
    January 2014
    December 2013
    November 2013
    October 2013
    September 2013
    August 2013
    July 2013

    Categories

    All
    Abdominal Pain
    Abdominal-pain
    Airway
    Back Pain
    Back Pain
    Bleeding
    Change-in-mental-status
    Chest Pain
    Dizziness
    Ecg
    Emboli
    Environmental
    Fever
    Gyn
    Headache
    Hypertension
    Infectious Disease
    Pain
    Pediatric Emergency
    Professionalism
    Psych
    Respiratory Distress
    Sepsis
    Shock
    Toxins
    Trauma
    Vomiting
    Weakness

    RSS Feed

    Tweets by @PedEMMorsels
Powered by Create your own unique website with customizable templates.
  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction