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Atrioventricular Blocks, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Impaired conduction between the atrium and the ventricle through the AV node or His–Purkinje system

  • 1st-degree AV block:

    • Prolonged conduction through the AV node

    • Ventricular impulses ar...

Diagnosis

Signs and Symptoms

History

  • 1st-degree AV block:

    • Asymptomatic

  • Type I 2nd-degree AV block:

    • Pulse irregularities

  • Type II 2nd-degree AV block and 3rd-degree block:

    • Exercise intolerance

    • Palpitations

    • Chest...

Treatment

Pre-Hospital

  • Transcutaneous pacing for unstable Type II 2nd- or 3rd-degree block

  • Atropine:

    • Avoid with Type II 2nd-degree block because it may precipitate complete heart block

    • Contraindicated in ...

Follow-Up

Disposition

Admission Criteria

Monitored bed: 
  • Type II 2nd-degree block

  • 3rd-degree block

Discharge Criteria

Asymptomatic 1st-degree and Type I 2nd-degree blocks: Ensure follow-up for further outpa...

Pearls and Pitfalls

  • Obtaining an EKG rapidly in symptomatic patients is paramount.

  • Once a high-degree AV block has been diagnosed, initiate transcutaneous pacing immediately.

  • Obtain a complete history f...

Additional Reading

  • Harrigan  RA, Chan  TC, Moonblatt  S, et al. Temporary transvenous pacemaker placement in the emergency department. J Emerg Med.  2007;32(1):105–111.

  • Olgin  JE, Zipes  DP. Speci...

Codes

ICD9

  • 426.10 Atrioventricular block, unspecified

  • 426.11 First degree atrioventricular block

  • 426.13 Other second degree atrioventricular block

  • 426.0 Atrioventricular block, complete

  • 426.12 Mobitz (type...

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