You are a third-year medical student on the first day of your cardiology rotation. Obviously, you are nervous and want to impress the attending physician, Dr, Jackson, who has made it clear that he is a very important man who doesn’t really have time to mess around with lowly medical students. “OK,” he says, “let’s see if you already know anything. Take a minute to look at Mrs. Svoboda’s chart, she’s a textbook case of what we see around here, and then let’s talk about it. ” Mrs.
Svoboda is an 81-year-old woman with congestive heart failure. She had smoked for 60 years, but was able to successfully quit when she received her diagnosis four years earlier. She was in the hospital because she had fainted at home. Her EKG pattern had revealed the presence of third-degree heart block and resulting bradycardia. Use the information from this sheet and any other reliable resources available to you to answer Dr. Jackson’s following questions. Questions 1. What is congestive heart failure? Congestive heart failure is when the heart is pumping at a weaker pace than normal.
The blood in somebody that is suffering from heart failure moves throughout their heart and their body slower, and the pressure in their heart is going to increase. The heart then suffers because it cannot pump enough oxygen and nutrients. Because of this, the kidneys will respond to this by making the body retail water and salt. This fluid will then build up all over the body and the body will become congested. This is then called congestive heart failure. 2. What is third-degree heart block? What would the EKG tracing of someone with third- degree heart block look like?
Third-degree block, also known as third-degree atrioventricular block is “a cardiac conduction system where there is no conduction through the atrioventricular node” (Budzikowski 2014). The patient will have severe bradycardia with independent atrial and ventricular rates. These patients may suffer from ventricular standstill, which can eventually lead to sudden cardiac death. Because the impulse in these people is blocked, a pacemaker will most likely be put in place to activate the ventricles. When there is complete heart block, capture beats or fusion will never be seen.
On a EKG of somebody with complete heart block, it would be represented by QRS complexes being conduction at their own rate and P waves would be totally independent. The ventricles are instead activating from a more distal focus. The rhythms that are taking place are called escape rhythms. There are junctional and ventricular escape rhythms. Junctional has narrow QRS complexes, while ventricular has wide QRS complexes. 3. Why would third-degree heart block cause bradycardia? Bradycardia is low heart rate. Bradycardia can arise because of two different things. First, the sinoatrial node may not function properly.
This could be because of a slow generation of impulses of because there is a block in the propagation of impulses. Because these are not functioning properly, the pacemakers that are in the heart will then become responsible for the impulse generation, and these will have intrinsicially slower rates. This condition is not necessarily harmful. However, it usually indicates bigger problems with the atrial conduction system. Atrial fibrillation is the more frequent result of it. Sometimes, the paroxysmal supraventricular tachycardia will all of the sudden stop, and this will lead to the sinoatrial node differing its normal sinus rhythm.
This will then lead to bradycardia, and may cause fainting. The other reason that bradycardia can arise is because of heart block. “Under these circumstances the sinoatrial node generates an appropriate impulse rate, but the impulses are not transmitted properly through the atrioventricular node and the his bundle” (Diethrich 2015). If the heart block progresses into third degree heart block a pacemaker is implanted in order for proper function. 4. What treatment would you recommend for Mrs. Svoboda?
There are many medications and treatments for somebody suffering with third degree heart block. I believe one of the most important treatments is the use of a pacemaker. Pacemakers are electronic devise that regulate the hear rate within a normal range. The pacemaker will take over Mrs. Svoboda’s heartbeat and restore it to its normal function. Another important thing for treatment is to stop the medications that cause the heart block.
These could be things such as beta-blockers, digoxin, and calcium channel blockers. Instead, you should replace them with medications that help increase the heart rate of Mrs. Svoboda. Some examples of things that would increase heart rate would be Atropine, Dopamine, and Isoproterenol.
Work Citied http://emedicine. medscape. com/article/162007-overview http://lifeinthefastlane. com/ecg-library/basics/complete-heart-block/ http://www. ekginterpretation. com/library/complete-heart-block/ http://www. britannica. com/EBchecked/topic/720793/cardiovascular- disease/261773/Bradycardia-and-heart-block http://www. freemd. com/third-degree-heart-block/treatment. htm.