How to interpret AV Heart Blocks on an EKG strip

have you ever been in clinicals and watched a nurse print off an EKG strip glanced at it and then run into the room to check on a patient do you want to be that nurse that can quickly detect a heart walk on a strip and take action hi guys my name is Marie and I have a nurse educator here at NRS ng I've been a nurse for over a decade as a telemetry and a medical surgical nurse and today I'm going to give you some quick tips to identify first second degree type one second degree type two and third-degree heart blocks all right before we get started you guys all know that as a nurse you have to know normal in order to recognize a heart block first we're going to take a look at this normal sinus rhythm on a six second EKG strip and we're just gonna break it down real quick it's probably review so we'll go quickly as you can see there is AP wave which is that tiny little dip right before the QRS complex and there's one P wave for every QRS in the strip and then following is the T wave after the big spike of the QRS so each tiny little box represents point zero four seconds and then together the big boxes represent point two seconds the QRS complex needs to be less than point one two seconds in order to be normal which it is on the strip and then the PR interval is less than point two that is the distance between the P wave and the QRS complex if you count out the QRS complexes you get nine in the strip and so that means you multiply it by ten to get the rate which is 90 beats per minute this is a regular rate which means that each QRS complex is the same distance from the next one and it's a normal finding so this is a normal sinus rhythm strip keep that in mind as we go through these heart box okay there are five steps to follow in order to determine whether or not your patients strip is showing a heart block number one we want to know if there's P waves present and how many so the P wave is the atria contracting and it's the little bump right before the QRS complex number two are the P waves regular so if you just take a caliper or a piece of paper and Mark between two P wave does it March out to be the same from one p-wave to the next all along the rhythm strip number three are the QRS complexes present and how many are there this determines the ventricular rate if you count the number of QRS complexes which is the big spike in one six second strip step number four are the QRS complexes regular and then number five we're going to measure the PR interval which is the distance between the P wave and the QRS complex and we're also going to measure the QRS width so following those five steps is going to give us the information that we need to figure out whether or not our patient is in a heart block and what type of heart block they may be in before we move on to the specific blocks I want to make sure you guys remember that the AV node is the gatekeeper this is the node that's in between the atria and the ventricles and this is where the beat is going to be slowed or not so it's the gatekeeper that brings the impulse from the top of the heart down to the ventricles okay let's go over first-degree AV blocks in a first-degree AV block the big thing to remember is that the P our interval is long that is the only difference between a first degree heart block and a normal sinus rhythm if you remember the PR interval normally is 0.2 seconds or less so anything greater than 0.2 is going to give us that first degree AV block a first-degree AV block is not a bad thing highly trained athletes have these many children have these they're actually pretty normal and they don't really cause any symptoms or signs first-degree AV blocks can be caused by drugs some cardiac drugs that slow the electrical impulse conduction through the AV node these include beta blockers digoxin and calcium channel blockers to name a few alright let's move on to second-degree heart block type 1 also known as a Winky Bock the big thing to remember with second-degree type 1 heart blocks is that there's a site of lengthening of the PR interval so the cycle starts normal and then it increases with each beat until it actually drops a QRS complex so then you go a whole rotation with no QRS and there's just that P wave when I was in school we would say marching out until it drops then you have a Winky Bock the problem is it's hard to remember that Winky Bop goes with second-degree AV block type 1 but if you remember to second-degree AV block type 1 is a cycle of lengthening of the PR interval you'll be good so in the second degree AV block type 1 the P waves are irregular as they are marching out over time and you know if you try to mark them out they're not going to line up but the QRS complexes are regular until the beat is dropped ok it's time to move on to second degree AV block type 2 so in the second degree type 2 heart block you have regular P waves but your regular QRS complexes there is no cycle and there is no pattern it's just dropped qrs's which makes the QRS waves irregular but you will be able to march out the P waves in a line but the QRS complexes will not march out you will have a missed beat in there a person in second-degree heart block type 2 is going to have symptoms usually so these symptoms range from fainting and dizziness to shortness of breath and even chest pain when a patient is in a second-degree heart block type 2 they can easily progress into a third-degree AV heart block this is the heart block that gets us the most concern so we need to be very diligent with this type of heart block and begin medical intervention right away so in a third-degree AV heart block both the P waves and the QRS complexes are regular they are beating independently of each other however so you can look at a heart strip and see a bunch of P waves but not very many QRS complexes because they are not matching up at all the atria will contract the ventricle will contract but they're completely independent of one another this requires immediate medical intervention here I show an EKG strip with a third-degree AV you park block and as you can see there are 1 2 3 4 5 P waves and only 3 QRS complexes so this person has an atrial rate of 50 and a ventricular rate of only 30 30 beats per minute is not good symptoms of a third-degree heart block include syncope confusion dis Nia chest pain and even sudden death so these patients need to be this is a medical emergency and they need intervention right away alright let's recap the thing to remember about a first degree heart block is that there's a long PR interval other than that it looks like normal sinus rhythm the thing to remember about a second-degree heart block type one is that the P waves are irregular with the cycle of lengthening PR intervals that March out until it drops a QRS complex the thing to remember about a second-degree heart block type 2 is that the P waves are regular and the QRS complexes are irregular you will see dropped beats in this as well and it can easily progress to a third-degree heart block in a third-degree heart block you have regular P waves and regular QRS complexes but they are beating independently of each other so nothing is sinking in the heart and this is a medical emergency alright guys that's it I hope this helps take the stress out of nursing school if you would like to learn more about EKG heart blocks head over to NRS ng comm and sign up for a trial stop struggling through nursing school alone we're here to help thanks for spending some time with me today and as always happy nursing

Channel: NURSINGcom w/Jon Haws, RN

Views: 107,299

Keywords: nclex, nursing, nursing school, med-surg, nrsng, academy, heart rhythms, ekg nursing, EKG, 1st degree av block, 2nd degree type 1, 2nd degree type 2, Mobitz II, 3rd degree heart block, how to tell the difference between heart blocks, how to interpret ekg, heart block explained, Wenchkebach, reading heart blocks ekg, heart blocks on ekg strip, nursing.com, Nursing school is hard, how to pass nursing school, how to pass the NCLEX, failing nursing school, study for nursing school

Id: pX3A7adPIYo

Length: 8min 18sec (498 seconds)

Published: Mon Nov 04 2019