Most images used are either mine, used under a creative commons license or in the public domain. Other images are from freely available medical journals or blogs with source or URLs stated in the slide.

SA node: 60 to 100 bpm

AV Junction: 40 to 60 bpm

Ventricle: <40 bpm

SA node: 60 to 100 bpm

AV Junction: 40 to 60 bpm

Ventricle: <40 bpm

Image from wikimedia users Madhero88 and Angelito7: https://en.wikipedia.org/wiki/Heart_block#/media/File:ConductionsystemoftheheartwithouttheHeart-en.svg

Images from Wikimedia User Fae: https://upload.wikimedia.org/wikipedia/commons/6/6d/A_doctor_taking_the_pulse_of_a_gouty_bachelor_surrounded_by_Wellcome_V0010995.jpg and https://upload.wikimedia.org/wikipedia/commons/6/69/A_physician_taking_the_pulse_of_a_female_patient_who_is_touc_Wellcome_V0016032.jpg

Image from Dr. S. Venkatesan: https://drsvenkatesan.files.wordpress.com/2013/08/irregular-cannon-waves-in-jvp-complete-heart-block.gif

3rd Degree or Complete Heart Block

• None of the P waves are conducted

• P waves and QRS complexes occur independently of each other

• R-R intervals are usually regular (junctional or ventricular escape rhythm)

Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/

Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/

SA node: 60 to 100 bpm

AV Junction: 40 to 60 bpm

Ventricle: <40 bpm

Complete heart block: http://commons.wikimedia.org/wiki/User:Jer5150

• R-R intervals are usually regular (escape rhythm)

• More P waves than R waves

• “PR” intervals are not constant / no pattern

• Escape rhythm can be junctional or ventricular

Complete heart block strip from Wikimedia user MoodyGroove: http://en.wikipedia.org/wiki/User:MoodyGroove

Escape Rhythms

• Junctional rhythm (40 to 60 bpm)

– Narrow QRS

– Retrograde P waves shortly before or after QRS, if any

• Ventricular rhythm (<40 bpm)

– Wide, “bizarre” QRS complexes

Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/

Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/

Image from Flickr User Helge V. Keltel: https://www.flickr.com/photos/17088227@N00/7147926407

Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/complete-heart-block/

From https://en.wikipedia.org/wiki/Dialysis#/media/File:Patient_receiving_dialysis_03.jpg

Pills Image from https://www.flickr.com/photos/emagineart

Diagnosis and Management of Cardiac Amyloidoses. Circulation.2005; 112: 2047-2060

Image from wikimedia User Kalumet: https://commons.wikimedia.org/wiki/File:Dilated_cardiomyopathy_B-Mode.jpg

Holter image from Wikimedia user Misscurry: https://en.wikipedia.org/wiki/Holter_monitor#/media/File:Alex_CM4000.jpg

Brignole et al. J Am Coll Cardiol 2011;58:167–73

Image from From Wikimedia user: https://commons.wikimedia.org/wiki/User:Stevenfruitsmaak

SA node: 60 to 100 bpm

AV Junction: 40 to 60 bpm

Ventricle: <40 bpm

Images

• Cover image originally Rainbow Heart by Bill Ward: https://www.flickr.com/photos/billward. Converted to black and white to sort of fit the bad pun and subject matter.

• Heart image with conduction system: Public Domain image from Gray’s Anatomy

• QRS complex: Public Domain image from Wikipedia user http://en.wikipedia.org/wiki/User:Agateller

• Road Block sign: http://en.wikipedia.org/wiki/File:Road_block.jpg

• Complete heart block: http://commons.wikimedia.org/wiki/User:Jer5150

• Complete heart block strip: http://en.wikipedia.org/wiki/User:MoodyGroove

• Junctional rhythm: http://www.flickr.com/photos/nottinghamvets/

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