Understanding 2nd Degree Heart Block on ECG

Introduction

Second-degree heart block is a type of atrioventricular (AV) block where electrical signals between the atria and ventricles are impaired. Recognizing this condition on an electrocardiogram (ECG) is crucial for proper diagnosis and management.

Types of 2nd Degree Heart Block

There are two types:

  1. Mobitz Type I (Wenckebach)

    • Progressive prolongation of the PR interval until a QRS complex is dropped.
    • Usually benign and often does not require treatment.
  2. Mobitz Type II

    • The PR interval is constant, but intermittently, a QRS complex is missing.
    • More dangerous because it can progress to complete heart block.

ECG Findings

  • Mobitz I: Gradually increasing PR interval followed by a dropped beat.
  • Mobitz II: Sudden loss of QRS complexes without PR lengthening.
  • Atrial rate > Ventricular rate: Indicates block in conduction.

Causes & Risk Factors

  • Aging and degeneration of the conduction system
  • Myocardial infarction (especially if it affects the AV node)
  • Electrolyte imbalances (e.g., hyperkalemia)
  • Medications (e.g., beta-blockers, calcium channel blockers, digoxin)

Treatment & Management

  • Mobitz Type I:
    • Usually no treatment if asymptomatic.
    • Monitoring for progression.
    • Adjusting medications if needed.
  • Mobitz Type II:
    • Often requires a pacemaker.
    • Medication adjustments and monitoring for complete heart block.

Conclusion

Identifying 2nd-degree heart block on an ECG is essential because Mobitz II can lead to serious complications. If you experience symptoms like dizziness or fainting, medical evaluation is necessary.

Source recommendations

1. American Heart Association Guidelines on Heart Block

  1. https://www.heart.org/en/health-topics/arrhythmia/about-arrhythmia/conduction-disorders
  2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000628
  3. https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines/algorithms
  4. https://professional.heart.org/en/guidelines-and-statements
  5. https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/algorithms/algorithmacls_bradycardia_200612.pdf

2. European Society of Cardiology Guidelines on Cardiac Arrhythmias

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
  2. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Supraventricular-Tachycardia
  4. https://pubmed.ncbi.nlm.nih.gov/36017572/
  5. https://www.ahajournals.org/doi/10.1161/01.cir.0000091380.04100.84

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