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On the ECG, you won’t see any warning before a beat is dropped as you would with type I seconddegree AV block. Don’t drop the beat In type II second-degree AV block, the PR and R-R intervals remain constant before the dropped beat. The arrhythmia frequently progresses to third-degree, or complete, heart block. Be careful. With type II seconddegree AV block, you won’t see a warning on the ECG before a dropped beat. What the ECG tells you • Rhythm: The atrial rhythm is regular. The ventricular rhythm can be regular or irregular.
Move the paper up slightly so the straight edge is near the peak of the R wave. With a pencil, mark the paper at the R waves of two consecutive QRS complexes, as shown. This is the R-R interval. Next, move the paper across the strip and line up those two marks with succeeding R-R intervals. If the distance for each R-R interval is the same, the ventricular rhythm is regular. If the distance varies, the rhythm is irregular. Use the same method to measure the distance between the P waves (the P-P interval) and determine whether the atrial rhythm is regular or irregular.
QT interval: Usually within normal limits. Type I seconddegree AV block is known as the footprints of Wenckebach. indd 49 10/7/2011 4:18:06 PM 50 RECOGNIZING CARDIAC ARRHYTHMIAS What to look for • Usually no symptoms • Possibly a first heart sound that becomes progressively softer with intermittent pauses • Hypotension or syncope (if ventricular rate is low) How it’s treated • For most patients, treat the underlying cause. • If hemodynamically symptomatic bradycardia is present, prepare to administer atropine.
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