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Fig. 37. c) complete third-degree A-V block

b) incomplete (first and second degree) block. The causes of a complete A-V block are:

— of organic character — myocardites, rheumatic cardites, stitching through conduction tracts in the course of operations;

— functional — in myocardial infarction toxins are formed having their influence on A-V node, but they are transitory;

— edema of tissues around conduction system as a result of inflammation (myocarditis), hyperkalemia, sharp elevation of n. vagus tone.

Here, clinically a rare pulse will be noted. In complete A-V nodal block independent P waves not connected with ventricular complex will be seen on the ECG. Ventricular complexes will be different as they originate from the excitation of various areas, and R-R intervals are identical. In this case sharp disorders of hemodynamics are observed. Morgagni-Adams-Stokes attacks (prolonged asystole on the ECG) are particularly grave, when, at some moment, a circulatory arrest occurs by the type of ineffective heart.

Hemodynamic shifts:

— bradycardia;

— increase of systolic volume;

— arterial hypertension with great pulse amplitude;

— increase of systolic pressure in the pulmonary artery and in the right
half of the heart;

— increase of peripheral resistance and arteriovenous difference by oxygen.
Clinical picture of asystole is presented in Table 12.

Table 12

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