Chapter III PATHOPHYSIOLOGY A. Schematic Diagram Precipitating Factors >pt.

with Congestive heart Disease >Hypertension >Myocardial Infarction >Beta Blocker Drug > Lifestyle Predisposing Factors >Age 60 years old and above >Family history of Hypertension

Narrowing and Spasm of the Blood lining Inadequate oxygen Delivery Deterioration of the cardiac nodal fiber Calcification & fibrosis of the Conduction System

Accelerate the degeneration of the conductivity system

Delay in Av Nodal, Atrial, His-Purkinje activation

Prolonged AV conduction

Progresses to conduction block

Decrease excitability of AV junction fibers

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Failed atrial impulse conduction to the ventricles

Intermittent AV block

Anteroseptal infarction or secondary sclerodegeneration

Decreased pumping Action of the heart

Absence of atrial impulse propagation

Complete Heart Block Or Third Degree atrioventricular Block

S/S >Hypotension >Bradycardia

If given Proper management Such as temporary Pacemaker Insertion, immediate stabilization will be achieved.

If not treated patient will experience the following complications such as: >Hemodynamically unstable > Syncope >Hypotension >Cardiovascular Collapse >or Death

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B. Narrative Complete heart block is caused by a conduction block at the level of the AV node, the bundle of His, or the bundle-branch Purkinje system. In most cases, the block occurs below the His bundle. A variety of disease also can influence AV nodal conduction. These include acute processes such as myocardial infarction, congestive heart disease, and hypertension. Other factor that contributes to this disorder are digitalis intoxication, excesses of beta blockers, excessive alcohol intake and cigarette smoking. Narrowing and spasm of the blood lining accelerates the degeneration of the conductivity system, thus causing inadequate oxygen delivery to the heart. Calcification and fibrosis of the conduction system occurs which leads to the deterioration of the cardiac nodal fiber. Since PR interval is determined by atrial, AV nodal, and His-Purkinje activation, delay in one or more of these structures can contribute to a prolonged PR interval. Decrease excitability of AV junction fibers which progresses to a conduction block. Intermittent AV block is present when some atrial impulses fail to conduct to the ventricles. Anteroseptal infarctions or secondary

sclerodegeneration occurs. When no impulse propagates to the ventricles, pumping action of the heart decreases and leads to third degree AV block or complete heart block. If given Proper management Such as temporary Pacemaker Insertion, immediate stabilization will be achieved. If not treated patient will experience the following complications such as Hemodynamically unstable, syncope, hypotension, cardiovascular collapse or Death.

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