Now who likes heart blocks as much as I do? I didn't see anybody raising their hand. But I really love heart blocks because to me, they're extremely easy to identify, come up with these rhymes and rhythms a great way to fool my brain into into helping me realize or diagnose what type of heart block I'm dealing with. So the whole, the whole key to identifying heart blocks, is looking at the P wave, and its association or dis association with the QRS complex, keeping in mind that the P wave tells us that the atria just fired and the QRS complex tells us that the ventricles just fired after it's received the information from the atria. So this is going to tell us a lot about heart blocks. Now there were basically four heart blocks.

I don't know why they just can't call them 123 and four, it seems like every physician in the world wants their name behind. Something but we'll go ahead and break these down for you. So the first one we'll speak about as a first degree heart block. Now the first degree heart block isn't really a block at all. What it is, is a delay of information between the atria and the ventricles. The ventricles are getting it, it's just getting a little bit lost on the way down there.

So with the first degree heart block, as you'll notice here, it's typically a brain aquatic rhythm, meaning it's less than 50 beats per minute. Your QRS complex is narrow, it is a regular rhythm, there is a P wave for every QRS complex, and the P wave is about the same distance from the QRS complex for every heartbeat. But as you'll notice, here, the P wave is a little bit further away from the QRS complex than we'd like it to be. So if you'd like to compare the normal sinus rhythm or sinus bradycardia to a first degree heart block, you'll notice a lot of similarities between them. But the One thing that will stand out is that P wave will be further away from the QRS complex than we'd like it to be, therefore showing that delay of information between the atria and the ventricles. So let's ask ourselves the same six questions ready?

Is it fast? Or is it slow? Is it regular? Or is it irregular? Is your QRS complex narrow? Or is your S complex wide?

Do you see a P wave? Is there a P wave for every QRS complex? And is the P wave in the same spot for every QRS complex? If you've answered those questions correct correctly, you've just identified your first degree heart block. Now here's how I can remember it just by arrive. So if you look at the at the cardiac rhythm here, what I like to do is is kind of trick my mind.

Like I said earlier, if you're ours are far from peas, you probably have the first degree Again, if your RS are far from PS, you'll probably have the first degree. Excellent moving on. Now let's talk about the second one. This heart block has three different names. It had the first name is a mobitz one. It can also be a second degree type one, or it can also be called a Winky Bock.

I know Dr. Winky Bock. He's got his fingers in a lot of pies, I guess. But regardless, here's how identify here's how to identify the Winky Bock. So the Winky Bock you can look at the P wave and its association and dissociation to the QRS complex. Now, as you can see here, the first beat the P wave is nice and tight. It's nice and close to the QRS complex.

The second beat, you'll notice that the P wave gets a little bit further away. And then the third beat you notice that the P wave is really far away from the QRS complex and the fourth beat you'll see that the atria fires but they're There's no ventricular response. There's no QRS complex with that P wave. And then the cardiac cycle just starts over again, it's recycling itself, it's doing the exact same thing. So there's definitely a dis association between the P wave and the QRS complex here, but it's predictable. We call this rhythm regularly irregular.

So here's my rhyme to figure out what this heart block is. Long, long, longer drop, must be the Winky Bock. And when I'm saying Long, long longer drop, I'm talking about those P waves and how they progressively get further away from the QRS complex. And then the QRS complex just forgets to show up at the party once that P wave is fired once the HP is fired on isn't it, I thought you'd be having a great time. So the next heart block is one of the more serious heart blocks. This is called a mobitz, two or a second degree type two.

Now these are a little bit harder to identify They don't actually look that bad. But in reality, the second heart blocks are pretty serious and they need to be taken seriously. So here we have a very common second degree type two or a mobitz. Two, you'll notice the first three beats, the P wave is nice and tight. It's very close to the QRS complex. Now the QRS complex is narrow.

Now this can be regular or irregular, it's typically irregular, as we can see here. So again, the first three complexes the P wave is nice and tight. There's a P wave for every QRS complex. And then you'll notice a P wave just kind of standing out there on its own, with no QRS complex next to it. So there's no ventricular response. Once again, this can be an irregular or regular rhythm, but typically it's irregular.

So how I like to identify this with my little rhymes is if you see a p that doesn't have a Q, you probably have mobitz two. Now, we can use that rhyme for our next heart block our final heart block. But I'll tell you why we can't. And what and we'll get into that here shortly. But the next one is going to be our third degree heart block or complete heart block. As you'll notice here, the rhythm is slow, it is free to Kartik.

But you'll also notice something different with the other heart blocks. The QRS complex was nice and narrow. Here. Do you see a nice narrow QRS complex? Nope, it's wide. So that tells us what part of heart is in control the ventricles correct.

Do we like the ventricles being in control? Absolutely not not their job. But in this case, he's bullying the atria. Now, here's what's happening here with this particular heart block. So the third degree heart block is a complete dissociation between the atria and between the ventricles. They're both doing what they want to do.

They're just not talking to each other, they're not communicating with each other. Think of it as a couple in a relationship. So, the wife, which I like to call the atria, is not speaking to the husband, which I like to call the ventricles. They're doing their own things. Now, people who are in a relationship and they're not constantly communicating on a consistent basis, what happens to that relationship, the relationship starts to die and then eventually ceases to exist. Well, that's what's going to happen with a complete or a third degree heart block.

So as you can see, the atria is mappable. You can actually take calipers or your two fingers and map out the P waves and they're the same distance apart. In a lot of cases, the ventricles will be mappable as well. They're just not communicating with each other. With that said, This relationship is in serious trouble and they need some therapy right away. So Here's the rhyme that I use to identify the third degree heart block.

If your P's and Q's do not agree, you probably have a third degree