Third degree AV block physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2] ; Aditya Ganti M.B.B.S. [3]
Overview
The physical exam is usually remarkable for bradycardia. JVP exam often demonstrates cannon A-waves as the atria and ventricles contract simultaneously, which results in significant pushing of the blood against the AV valve. Thus a very large pressure wave runs up against the vein. Particularly with heart rates below 40/min, patients might also demonstrate findings consistent with decompensated heart failure, respiratory distress, and hypoprofusion such as diaphoresis, tachypnea, altered mental status, retraction, cool skin, and decreased capillary refill.
Physical Examination
Appearance of the Patient
The patient may present with altered mental status because of hypoperfusion. Patient may be diaphoretic and pale experiencing severe chest pain if the cause of complete heart block is myocardial infarction.
Vitals
Pulse
- Bradycardia may be present.
Respiratory Rate
- Tachypnea may be present.
Skin
- Skin rash may be present if the cause of complete heart block is endocarditis or rheumatic fever or Lyme disease.
Neck
- Cannon 'a' waves may be seen often.
- Elevated JVP may be seen if heart failure is present.
Lungs
- Basilar rales may be heard.
Heart
Auscultation
- S3 gallop may be heard in the presence of heart failure.
Extremities
- Pedal edema may be present.