ECG Blog #105 (ECG Video-Blog-8) Basics of AV Block

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This is the 8th installment of my ECG Video Blog. This 58-minute video covers the Basics of AV Block — including Pearls on ECG diagnosis — clinical relevance — and distinction from AV Dissociation.

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NOTE: There are advantages to using a video format format. These include:

• Ability to illustrate concepts not done full justice by the written word.
• Greater dispersion of my content through Google & YouTube. This material is free for anyone to use.

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LINKS to my ECG Video-Blog installments:

• ECG Video-Blog #1-Revised (= Blog #95) — Is there AV Block?
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• ECG Video-Blog #2 (= Blog #96) — Bundle Branch Blocks
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• ECG Video-Blog #3 (= Blog #97) — SVT with marked ST Depression
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• ECG Video-Blog #4 (= Blog #98) — Clinical Arrhythmia Mgmt (Part I )
• ECG Video-Blog #5 (= Blog #99) — Clinical Arrhythmia Mgmt (Part 2 )
• ECG Video-Blog #6 (= Blog #100) — Clinical Arrhythmia Mgmt (Part 3 )
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• ECG Video-Blog #7 (= Blog #101) — Wide Tachycardia + Chest Pain
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• ECG Video-Blog #8 ( = Blog #105) — Basics of AV Block
•    Easy YouTube Link for AV Block (www.avblockecg.com)
•    Click Here for Timed Contents to the AV Block Video!
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• ECG Video-Blog #9 ( = Blog #110) — Complete AV Block? / Laddergrams
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• ECG Video-Blogs #10,11,12 ( = Blog #113) — Rhythm Diagnosis Basics
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• ECG Video-Blog #13 ( = Blog #116) — Essentials of Axis / Hemiblocks
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• ECG Video-Blog #14 ( = Blog #117) — Brugada Syndrome
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• ECG Video-Blog #15 ( = Blog #118) — QRST Changes
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• ECG Video-Blog #16 ( = Blog #120) — Giant T Waves

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     My goal in this 58-minute video series is to review the approach to diagnosing the AV Blocks. This starts with recognizing what AV Block is (and is not) — what conditions may mimic AV Block (ie, blocked PACs) — and how to distinguish Complete AV Block from AV Dissociation. Focus is on the 3 types of 2nd-Degree AV Block (Mobitz I; Mobitz II; 2-to-1 AV Block) — and on how to make a definitive diagnosis of Complete AV Block.

• Below in Figure 1 — a sample of some issues discussed. I believe this video brings the topic to life!

Figure-1: Slide reviewing the causes of AV Dissociation. The tracing illustrates Sinus Bradycardia with resultant AV Dissociation by "default" (ie, due to slowing of the sinus rate). NOTE — Enlarge by clicking on Figures — Right-Click to open in a separate window.

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GO TO – http://youtu.be/Ih5a1ER2umI - on YouTube to view this ECG Video (58 minutes). The "Easy" Link = www.avblockecg.com -

• Click Here  — for a Timed CONTENTS of Video-Blog #8 on AV Blocks.
• Please also check out my ECG Video Blog page on Google. The link is easy to remember = www.videoecg.com -

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NOTE: For a Power Point Show (.ppsx) version of my Video Blogs - CLICK HERE. This folder will contain links to download a .ppsx version that allows faster viewing:

• Download the .ppsx to your computer desktop.
• The PPT show is without automatic sound. YOU activate only the Audio clips you want.
• Hover your mouse over the highlighted Audio. You may play and/or pause if/as you like.
• Feel free to use this .ppsx for teaching with my blessings!

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ECG Blog #104 (My ECG Guru Comments-2) - AV Blocks/AV Dissociation

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As a source of tracings for practice and/or teaching — I have decided to LINK many of the ECGs I have commented on as Contributing Expert for ECG Guru (www.ecgguru.com). 

• NOTE: The ECG Guru is dedicated to providing free resources for ECG Teachers and their Students. Search the ECG Guru site if you ever are in need of cases on a particular subject.

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Regarding My Comments on the ECG Guru:

• ECG Blog #103 — Acute MI ECGs (Comments #848; 838; 823; 819; 801 ).
• ECG Blog # 104 (Comments #828; 836) — AV Blocks/AV Dissociation.
•    ECG Blog #105 — AV Block Basics Video (www.avblockecg.com).
• ECG Blog #123 — LINKS to My ECG Guru Posts (Volume-1).
• ECG Blog #124 — Using a Normal ECG for Teaching (ECG Guru).

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ECG for Comment #828 — on the ECG Guru (Instructor Collection — posted 9/16/2014):

This ECG was obtained from an 84-year old man who became dizzy and fell. He was not injured in the fall. Subsequent ECGs showed progressive slowing that clearly required insertion of a pacemaker.

• How would you interpret this 12-lead ECG — given that this 84-year old man presented with syncope?
• Is there complete AV Block?
• Is there complete AV Dissociation? Are you certain?
• What happens at the end of this 12-lead ECG?

Figure-1: ECG obtained from an 84-year old man admitted for syncope. (Our gratitude to Sebastian Garay for use of this case and all tracings.).

• For My Interpretation — See ECG Guru Comment-828.

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ECG for Comment #836 — on the ECG Guru (Instructor Collection — posted 11/4/2014):

This ECG was obtained from an 62-year old man. Unfortunately, there is no clinical information available.

• How would you interpret this 12-lead ECG and long lead II rhythm strip? 
• Can you explain why the rhythm is irregular? (HINT — Why did I place this tracing with my ECG Guru Comments about AV block?)
• Can you explain the change in QRS morphology?

Figure-1: ECG obtained from an 62-year old man.  No history available ...

• For My Interpretation — See ECG Guru Comment-836.

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ECG Blog #103 (My ECG Guru Comments-1) - Acute MI Tracings

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As a source of tracings for practice and/or teaching — I have decided to LINK many of the ECGs I have commented on as Contributing Expert for ECG Guru (www.ecgguru.com). 

• NOTE: The ECG Guru is dedicated to providing free resources for ECG Teachers and their Students. Search the ECG Guru site if you ever are in need of cases on a particular subject.

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Regarding My Comments on the ECG Guru:

• ECG Blog #103 — Acute MI ECGs (Comments #848; 838; 823; 819; 801 ).
• ECG Blog #104 (Comments #828; 836) — AV Blocks/AV Dissociation.
•    ECG Blog #105 — AV Block Basics Video (www.avblockecg.com).
• ECG Blog #123 — LINKS to My ECG Guru Posts (Volume-1).
• ECG Blog #124 — Using a Normal ECG for Teaching (ECG Guru).

= = = = = = = = = = = = = = = = = = = = = = = = =
= = = = = = = = = = = = = = = = = = = = = = = = =

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ECG for Comment #848 — on the ECG Guru (Instructor Collection — posted 1/16/2015):

This ECG was obtained from a patient presenting to the ED (Emergency Department) with new-onset chest pain. Unfortunately — No follow-up is available ...

• How would you interpret this ECG — given that the patient has new-onset chest pain?
• What is the "culprit" artery likely to be?

Figure-1: ECG obtained from a patient with new-onset chest pain.

• For My Interpretation — See ECG Guru Comment-848.

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ECG for Comment #838 — on the ECG Guru (Instructor Collection — posted 11/16/2014):

This ECG was obtained from a patient with chest pain. Unfortunately — additional details are not available ...

• How would you interpret this ECG — given the not unexpected history of chest pain?
• What is the "culprit" artery likely to be?
• Do the ECG findings shown here suggest LMain "disease"?

Figure-1: ECG obtained from a patient with chest pain.

• For My Interpretation — See ECG Guru Comment-838.

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ECG for Comment #823 — on the ECG Guru (Instructor Collection — posted 8/29/2014):

This ECG was obtained from an 88-year old woman who presented to the ED (Emergency Department) in cariogenic shock. She apparently had been "ill" for several days prior to arrival in the ED.

• What would you expect to find on cardiac catheterization? (Cath films are shown at the above link on ECG Guru).
• Is all that you see on her ECG likely to be new?

Figure-1: ECG obtained from an 88-year old woman who presented in cardiogenic shock. What would you expect to find on cath?

• For My Interpretation — See ECG Guru Comment-823.

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ECG for Comment #819 — on the ECG Guru (Instructor Collection — posted 11/16/2014):

This ECG was obtained from a patient found to have LMain occlusion on cath. Unfortunately — additional details are not available ...

• Interpret the ECG. How many abnormal findings can you detect?
• Comment on the cath findings.
• Can one distinguish on ECG between proximal LAD vs LMain occlusion?

Figure-1: ECG obtained from a patient with LMain occlusion. Are you surprised by this cath finding?

• For My Interpretation — See ECG Guru Comment-819.

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ECG for Comment #801 — on the ECG Guru (Instructor Collection — posted 7/5/2014):

The computer interpreted the rhythm for this tracing as, "AFib with PVCs". Unfortunately — additional details are not available ...

• Do you agree with the computerized interpretation of the rhythm?
• What else is going on?
• Which arm should you check first on the patient? (ie, What is the likely source of the artifact?).

Figure-1: ECG with lots of artifact ... Is the rhythm AFib (as the computer says)? What else is going on?

• For My Interpretation — See ECG Guru Comment-801.

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