How to differentiate heart blocks

Electricity in the heart runs through a very predictable pattern

By Jon Puryear

Learning about the different heart blocks is always a challenge for beginning students in cardiac electrophysiology.

How do they happen? How can you tell them apart? How do they affect the patient? These are but a few of the questions surrounding this particular class of ECG rhythm abnormalities.

Basic principles
Electricity in the heart runs through a very predictable pattern. Originating in the right atrium, the electrical impulse follows specialized electrical pathways in order to ensure that the heart's chambers contract in a very organized manner.

Occasionally the signal gets interrupted somewhere along the way.

One type of interruption is at the atrioventricular junction, of AV junction. This area of the heart normally acts as a gatekeeper to the flow of electricity from the upper atria to the lower ventricles.

If this part of the conduction tissue is injured, the rate of electrical flow can slow or stop altogether. In other words, the signal gets blocked — hence the name, heart blocks.

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About the author

Jon Puryear, NREMT-P, has been active in EMS since 1983. He has been an active paramedic since 1992 including being an educator and Field Training Officer for several employers. He was the Assistant to the Medical Director for Dr. John Griswell in Ft. Worth, Texas, for EPAB/MedStar EMS and the Education/Clinical Coordinator for CareFlite in the Dallas/Ft. Worth Metropolitan area. Jon is the owner of Jon Puryear EMS CE, performing online live streaming and recorded EMS CE classes and refreshers. The live online classes are taught in a virtual instructor-led online live classroom, which allows the student to participate in "real time." These classes may be taken from any computer or iPad/Apple TV with internet access and no travel is required. Many recorded classes are available in his online Learning Management System. Jon performs a 16 hour NREMT prep onsite to initial programs, and also a recorded version online designed to prepare students for their NREMT written examination. You may contact Jon and obtain more information about his services at www.jonpuryear.com and jon.puryear@ems1.com.

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