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The Journal of Emergency Medicine
Volume 11, Issue 1,
, Pages 47-54
Acute atrioventricular (AV) block occurs frequently in patients with myocardial infarction. Atrioventricular block is also a common manifestation of sclerodegenerative conduction system disease. Occasionally, heart block results from drug toxicity, hyperkalemia, cardiac valvular calcification, myocarditis, or infiltrative cardiomyopathy. Second-degree AV block is a form of “incomplete” heart block, in which some, but not all, atrial beats are blocked before reaching the ventricles. Mobitz type II second-degree block is an old term, which refers to periodic atrioventricular block with constant PR intervals in the conducted beats. The distinction between type II and type I block is descriptive; of greater importance to the clinician is the anatomic site of the block and the prognosis. In Mobitz type II block the site is almost always below the AV node; in Mobitz type I block the site is usually within the AV node. Type 11 AV block is more likely to progress to complete heart block and Stokes-Adams arrest. In most cases of second-degree heart block, including cases of 2 : 1 conduction, it is possible to determine the site of the AV block (intranodal or infranodal) using information about the age of the patient, the clinical setting, and the width of the QRS complex on the surface electrocardiogram. Second-degree atrioventricular block must be distinguished from other “causes of pauses.” Nonconducted premature atrial contractions and atrial tachycardia with block are common conditions, which may mimic second-degree AV block.
- L.M. Mangiardi et al.Bedside evaluation of atrioventricular block with narrow QRS complexes: usefulness of carotid sinus massage and atropine administration
Am J Cardiol.
- J. HayBradycardia and cardiac arrhythmia produced by depression of certain functions of the heart
- K. Wenckebach
Beitrage Zurkenntis der Menschlichen Herztatigkeit
Arch Anat Physiol (Physiol Abth)
- W. Mobitz
Uber dei Unvollstandige Storung der Erregungsuberleitung Zwischen Vorhof and Kammer des Menschlichen Herzens
Z Geisamte Exp Med.
- J.I. Hart
Clinical implications of atrioventricular and intraventricular conduction abnormalities. I
- H.J.L. Marriott
- O.S. Narula
His bundle electrocardiography and clinical electrophysiology
- E.K. Chung
There are more references available in the full text version of this article.
- Reversible Causes of Atrioventricular Block
2021, Cardiac Electrophysiology Clinics(Video) 2nd Degree Type 2 AV Block ECG - EMTprep.com
- The asymptomatic teenager with an abnormal electrocardiogram
2014, Pediatric Clinics of North America
- John Hay and the earliest description of type II second-degree atrioventricular block
2001, American Journal of Cardiology
- Cardiac arrhythmia diagnosis
1995, American Journal of Emergency Medicine
Cardiac dysfunction is often manifested as arrhythmia, with disruption of the normal periodicity and regularity of electromechanical activity. Cardiac arrhythmias, or abnormalities of cardiac rhythm, are associated with a diverse group of conditions, including congenital, metabolic, structural, physiological, and immunological, and infectious abnormalities. Dysarrhythmia may also be classified as primary because of endogenous electrical abnormalities, or secondary, because of exogenous influences such as ischemia or adrenergic stimuli. Clinical arrhythmia syndromes begin with a single asymptomatic abnormal complex that is benign, progressing to grouped, sustained complexes associated with worsened symptoms and outcome. Proper diagnosis of arrhythmia reflecting symptomology and outcome is essential in acute cardiac care.
Bradycardia and cardiac conduction delay guideline update
2020, AACN Advanced Critical Care
Mobitz type II atrioventricular heart block after candlenut ingestion
2020, Journal of the American Osteopathic Association
Research articleLinfoma primario de ovario
Progresos de Obstetricia y Ginecología, Volume 56, Issue 8, 2013, pp. 432-435
La afectación del tracto genital femenino en linfomas, particularmente del ovario, es un proceso bien conocido y ocurre en la mayoría de los casos como consecuencia de una enfermedad linfática diseminada o como manifestación inicial de enfermedad oculta.
El linfoma primario de ovario, sin embargo, es una entidad extremadamente rara.
Los síntomas más frecuentes en el momento del diagnóstico son dolor abdominal o masa pélvica. El tratamiento estándar consiste en cirugía combinada con quimioterapia.
Se presenta un caso de linfoma primario de ovario según los criterios diagnósticos establecidos por Fox y Langley en 1976.
Involvement of the female genital tract in lymphoma, especially of the ovaries, is a well-known process and usually develops as a result of disseminated lymphatic disease or as the initial manifestation occult disease. Primary ovarian lymphoma, however, is extremely rare. The most frequent symptoms at diagnosis are abdominal pain and pelvic mass. Standard treatment consists of surgery and chemotherapy. We report a case of primary ovarian lymphoma and discuss its features in relation to the diagnostic criteria set forth by Fox and Langley in 1976.(Video) Second Degree Heart Block - Mobitz Type II
Research articleFemale Sexual Function Following Surgical Treatment of Stress Urinary Incontinence: Systematic Review and Meta-Analysis
Sexual Medicine Reviews, Volume 6, Issue 2, 2018, pp. 224-233
The impact of surgery for stress urinary incontinence (SUI) on female sexual function has received attention in the medical literature, but not in a structured manner.
To assess the most recent evidence on the impact of surgical management for female SUI on female sexual function.
The review and meta-analysis of available articles published in Medline, Cochrane, LILACS, SCOPUS, Web of Science, CINHAL, and EMBASE included prospective randomized and non-randomized studies that assessed patients who underwent surgical treatment for UI through 2 validated questionnaires: the Pelvic Organ Prolapse Urinary Incontinence Sexual Questionnaire (PISQ-12) and the Female Sexual Function Index (FSFI).
The following terms were searched: (urinary incontinence OR female OR woman OR women) AND (suburethral slings OR transobturator tape* OR transobturator suburethral tape OR trans-obturator tape* OR urethral sling* OR midurethral sling* OR mid-urethral sling* OR “standard midurethral slings” OR tensionless vaginal tape* OR mini sling* OR Burch* OR “Burch colposuspension” OR “urologic surgical procedures” OR “tension-free vaginal tape” OR pubovaginal sling) AND (sexual behavior OR “Female Sexual Function Index” OR FSFI OR sexual function OR “Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire” OR PISQ-12).
1,043 articles were retrieved; 9 studies were included for qualitative analysis and 4 were included for meta-analysis. 25 articles were excluded because they used questionnaires other than the FSFI and PISQ-12. Meta-analysis of 2 studies composed of 411 women who underwent to retropubic and transobturator sling intervention and completed the PISQ-12 questionnaire showed an increase in sexual function of 2.40 points after transobturator compared with retropubic sling intervention (95% CI=−2.48 to−2.32; I2= 35%, P<.00001). However, 2 other studies composed of 183 women comparing the same techniques, but using the FSFI, did not show a statistically significant difference (95% CI=−1.77 to 3.78; I2= 0%, P= .48).
The impact of UI surgery on sexual function is uncertain because of the imprecision of the effect and inconsistency among studies. Only limited evidence on the impact of the transobturator vs the retropubic sling was found.
Bicudo-Fürst MC, Borba Leite PH, Araújo Glina FP, etal. Female Sexual Function Following Surgical Treatment of Stress Urinary Incontinence: Systematic Review and Meta-Analysis. Sex Med Rev 2018;6:224–233.
Research articleLatanoprost for glaucoma: primum non nocere
The Lancet, Volume 386, Issue 9994, 2015, pp. 651-652(Video) Second Degree Heart Block - Electrocardiogram (ECG/EKG) Interpretation
Research articleAre Diabetes Care Providers Too Glucocentric?
Canadian Journal of Diabetes, Volume 40, Issue 6, 2016, pp. 479-481
Research articleLifestyle factors and small intestine adenocarcinoma risk: A systematic review and meta-analysis
Cancer Epidemiology, Volume 39, Issue 3, 2015, pp. 265-273
Although the incidence of small intestinal adenocarcinoma (SIA) is low, rates are increasing and little information regarding modifiable lifestyle risk factors is available.
To provide a systematic review of lifestyle factors and SIA risk.
Ovid MEDLINE, EMBASE and Web of science were searched from inception to week 1 October 2013. Nine publications that reported on SIA risk in relation to alcohol intake (n=6), tobacco smoking (n=6), diet (n=5), body mass (n=3), physical activity (n=1), hormone use (n=1) and/or socio-economic status (n=3) were retrieved. Results for alcohol, smoking and SIA risk were pooled using random-effects meta-analyses to produce relative risks (RR) and 95% confidence intervals (CI).
The summary RR for individuals consuming the highest versus lowest category of alcohol intake was 1.51 (95% CI 0.83–2.75; n=5 studies) with significant increased risks emerging in sensitivity analysis with reduced heterogeneity (RR: 1.82, 95% CI: 1.05–3.15; n=4 studies). The pooled SIA RR for individuals in the highest versus lowest category of smoking was 1.24 (95% CI 0.71–2.17; n=5 studies). In relation to dietary factors, high fibre intakes and normal body weight may be protective, while high intakes of red/processed meat and sugary drinks may increase SIA risk. Evidence on socio-economic status and SIA risk was equivocal. Data on other factors were too sparse to draw any conclusions.
Alcohol may be associated with an increased risk of SIA. Further investigation of lifestyle factors, particularly alcohol, smoking and diet, in the aetiology of this cancer is warranted in large consortial studies.
Research articleEmergency department monitor alarms rarely change clinical management: An observational study
The American Journal of Emergency Medicine, Volume 38, Issue 6, 2020, pp. 1072-1076
Monitor alarms are prevalent in the ED. Continuous electronic monitoring of patients' vital signs may alert staff to physiologic decompensation. However, repeated false alarms may lead to desensitization of staff to alarms. Mitigating this could involve prioritizing the most clinically-important alarms. There are, however, little data on which ED monitor alarms are clinical meaningful. We evaluated whether and which ED monitor alarms led to observable changes in patients' ED care.
This prospective, observational study was conducted in an urban, academic ED. An ED physician completed 53 h of observation, recording patient characteristics, alarm type, staff response, whether the alarm was likely real or false, and whether it changed clinical management. The primary outcome was whether the alarm led to an observable change in patient management. Secondary outcomes included the type of alarms and staff responses to alarms.(Video) Second degree type two heart block
There were 1049 alarms associated with 146 patients, for a median of 18 alarms per hour of observation. The median number of alarms per patient was 4 (interquartile range 2–8). Alarms changed clinical management in 8 out of 1049 observed alarms (0.8%, 95% CI, 0.3%, 1.3%) in 5 out of the 146 patients (3%, 95% CI, 0.2%, 5.8%). Staff did not observably respond to most alarms (63%).
Most ED monitor alarms did not observably affect patient care. Efforts at improving the clinical significance of alarms could focus on widening alarm thresholds, customizing alarms parameters for patients' clinical status, and on utilizing monitoring more selectively.
Copyright © 1993 Published by Elsevier Inc.
Second-degree AV block Type 2 (Mobitz), is a bradycardic rhythm caused by an irregular block of atrioventricular conduction below the AV node. Learn more here.
A second-degree atrioventricular (AV) block type II is also known as Mobitz type II second-degree AV block.. A second-degree AV block type II is an unstable warning rhythm that can lead to a complete heart block (third-degree AV block) or ventricular asystole without proper identification and treatment.. Atrial rate is regular, ventricular rate is bradycardic (< 60 beats per minute) Consistent, regular P waves More P waves than QRS complexes Uniform PR intervals QRS complex drops unpredictably When present, QRS complex is often wide A regular pattern of blocked atrial depolarizations (P waves) may occur before conduction to the ventricles (QRS complex) is achieved, demonstrated by a recurring P: QRS ratio of 2:1 or 3:1 (or more). Initial steps the healthcare provider should take in caring for a patient, according to the Advanced Cardiac Life Support (ACLS) Primary Assessment, are to manage the patient's airway, provide supplemental oxygen if needed, determine the patient's cardiac rhythm, and monitor vital signs.. In determining that an adult patient is symptomatic with a consistent bradyarrhythmia (such as a second-degree AV block type II) and displays signs and symptoms of poor perfusion (as previously described), the healthcare provider should utilize the ACLS Adult Bradycardia Algorithm to guide treatment.. Atropine For the patient with poor perfusion due to a consistent second-degree AV block type II, the ACLS Adult Bradycardia Algorithm recommends starting with 1mg of atropine administered intravenously, which can be repeated every 3-5 minutes, up to a total dose of 3mg.. Although atropine is indicated as a first-line medication in the ACLS Adult Bradycardia Algorithm, patients with a second-degree AV block type II may not respond to this medication or it may worsen the heart block, increasing the risk for clinical deterioration to a complete heart block or ventricular asystole.. Because there is a risk for patients with a cardiac rhythm of a second-degree AV block type II to deteriorate clinically into a complete heart block (third-degree AV block) or ventricular asystole, it is imperative that pacing be considered in patients who are hemodynamically unstable due to bradycardia.. TCP can be performed by ACLS providers and should be urgently considered in symptomatic patients experiencing poor perfusion with a second-degree AV block type II.. A second-degree AV block type II occurs when AV conduction is intermittently blocked below the AV node.. In a second-degree AV block type II, AV conduction is irregularly blocked below the AV node.. In a third-degree AV block (also known as a complete AV block), atrial impulses cannot initiate ventricular contraction, resulting in an escape rhythm that paces the ventricles at an inherent rate.
An electrical impulse from the sinoatrial node has to travel through the atria, to the atrioventricular node, and down the His-Purkinje system to reach the ventricles and create a ventricular contraction. This process is reflected on ECG as the PR interval which leads to a QRS complex. A delay in conduction in this system results in an atrioventricular conduction block or a prolongation of the PR interval on ECG. Conduction blocks are classified as either first-degree block, second-degree block, or third-degree block. The second-degree atrioventricular block is the focus of this activity. There are two types of second-degree atrioventricular blocks: Mobitz type I, also known as, Wenckebach and Mobitz type II.
There are two types of second-degree atrioventricular blocks: Mobitz type I, also known as Wenckebach and Mobitz type II.. There are two types of second-degree atrioventricular blocks: Mobitz type I, also known as, Wenckebach and Mobitz type II.. Mobitz type II is rarely seen in patients without structural heart disease.. In Mobitz type I (Wenckebach) there is a progressive prolongation of the PR interval (AV conduction) until eventually an atrial impulse is completely blocked.. Be aware that if more than one P wave is not conducted this is no longer a Mobitz type II and is considered a high degree AV block.. Routine imaging is not required for initial evaluation of second-degree atrioventricular block.. Mobitz 2 heart block.
Learn how to identify and treat Second-Degree AV Block Type I (Wenckebach or Mobitz Type I) following the ACLS and PALS guidelines.
If the patient with bradycardia has a second-degree AV block type I (or other bradyarrhythmia) and is symptomatic, it is crucial to determine if presenting signs or symptoms are due to the slowed heart rate; this would then be considered unstable bradycardia.. Symptomatic patients with a second-degree AV block type I generally respond to atropine; permanent cardiac pacing for patients with a second-degree AV block type I is uncommon.. If the patient with a bradyarrhythmia such as a second-degree AV block type I continues to demonstrate signs and symptoms of unstable bradycardia after the use of atropine, transcutaneous pacing (TCP) may be utilized.. A second-degree AV block type I bradyarrhythmia is often benign; many patients are asymptomatic.. Symptomatic patients with a second-degree AV block type I generally respond to the use of atropine.. A second-degree AV block type I occurs at the AV node of the heart.. An ECG for this rhythm would reflect that P waves are regular, the PR interval is consistent, and (similar to a second-degree AV block type I) there will be more P waves than QRS complexes though the dropped QRS complex occurs unexpectedly in a second-degree AV block type II.
Second-degree atrioventricular (AV) block occurs when regular atrial systoles (ie, non-premature atrial systoles) intermittently fail to conduct to the ventricles. Second-degree AV block may occur in many different patterns, and the block may be physiologically located at any level between the atria and ventricles.
On the basis of certain ECG characteristics, second-degree AV block is divided into Mobitz I AV block (or Wenckebach AV block) and Mobitz II AV block (or non-Wenckebach (fixed) AV block).. The most common pattern of Wenckebach second-degree AV block consists of progressive prolongation of the PR interval in consecutive beats leading up to a nonconducted P wave; this pattern is known as Mobitz I (Wenckebach) AV block.. A common pattern of second-degree atrioventricular (AV) block consists of gradual prolongation of the PR interval leading up to a nonconducted P wave; this pattern is known as Wenckebach AV block, or Mobitz I AV block.. The causes of second-degree AV block are often the same diseases that cause congenital or acquired complete AV block.. In fetuses, second-degree and third-degree AV blocks are often associated with complex and changing atrial and ventricular rhythms.. Progressive familial heart block of Mobitz type II is a rare entity in which first-degree AV block progresses to second-degree and third-degree AV block and, sometimes, to dilated cardiomyopathy.. Cause of atrioventricular block in patients after heart transplantation.. A common pattern of second-degree atrioventricular (AV) block consists of gradual prolongation of the PR interval leading up to a nonconducted P wave; this pattern is known as Wenckebach AV block, or Mobitz I AV block.