Brandon Fainstad, MD
- Determine key features of a A-V dissociation to identify complete heart block
Plan to spend 5 minutes familiarizing yourself ECG. Have the image pulled up on the presenting screen or monitor. Ask for a full read of the ECG. If the learner has not done so already, ask them to commit to a rhythm
Teaching point: Sinus rhythm is defined by “a p before every qrs and a qrs after every p”. If you have a qrs without a p there are premature ventricular contractions (PVCs) or ventricular escape. If you have a p without a qrs there is a second or third degree AV block. This is a third degree because there is complete dissociation. None of the p waves are conducted as evidence of a regular ventricular rate with the same morphology.
Complete (third degree) AV block with an atrial rate around 65 and a ventricular rate around 40. Left axis deviation with a right bundle branch block and possible prior inferior infarct.