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The patient is having
Heart blocks classification
Types of SA nodal blocks
Types of infra-Hisian block
What should be excluded from the list of administered to the patient medications
ECG changes are specific for
Donetsk National medical university named after M. Gorky
Methodic guidelines for the 5th year students
Self-training on the practical study
at the Internal medicine # 1 department
Donetsk – 2009
V. V. Adarichev
N. V. Kalinkina, MD
T.A. Parkhomenko, MD, PhD, Internal medicine #2 department
R.V. Basiy, MD, PhD, Anatomy department.
Heart blocks are common in clinical practice of physicians. Any heart and vessel disorder may result in diagnosing of heart bocks which could burden an ongoing disease and lead to serious and even fatal complications.
This is a basis for studying various aspects of blocks. Knowledge of pathologic physiology, and heart conductive system anatomy is required for better understanding of the topic. As conduction disorders are very common, they could be met in practice of any specialty doctors. That is why knowledge in the current topic might be very useful.
II. Aims of studying the topic
^ you need to know how to differentiate heart blocks, define main strategies of treatment and approach to the patient, give urgent help to patients with heart blocks in emergent conditions .
Literature for material revise:
Tests of initial level
1. The patient D., 67 y.o. had ECG-changes (see below):
These changes are caused by:
A. Right His Bundle Block (RHBB).
B. Frederique syndrome.
C. 1st grade AV-block.
D. Mycardial infarction (MI).
E. Left His Bundle Block (LHBB).
2. The patient B., 56 y.o., has an 2nd degree AV-block type 2.
Which from the listed are NOT the etiologic factors for heart blocks:
C. digoxin treatment.
D. M-choline blockers treatment.
E. high vagus tone.
3. In the patient B., 56 y.o., who suffers fron IHD, and having 2nd degree AV-block 2 type syncope suddenly has developed. Heart rate 36 bpm, regular, of different filling. BP 70/40 mm Hg.
A. Stokes-Adams syndrome.
C. Clerk-Levi-Critescou (CLC) syndrome.
D. vena cava superior syndrome.
E. coronary sinus syndrome.
4. Complete RHBB differs from incomplete RHBB by duration of:
5. Which are the leads to measure internal deviation time in when LHBB is suspected?
C. I, aVL, V5-6
E. III, aVF
IV. Study plan
The following topic parts should be studied to archive aims listed above:
1. Heart blocks etiology and pathogenesis.
2. Classification of heart blocks.
3. Methods for clinical and instrumental heart blocks’ diagnosing.
4. Conduction disorders’ differential diagnostics.
5. Urgent conditions caused by heart blocks.
6. Treatment of conduction disorders and emergencies caused by heart blocks.
Literature for studying theoretical aspects of the topic:
Short methodic guidelines for the classes on the topic “Heart blocks”
First the teacher checks students’ initial knowledge level using initial level tests and corrects it if necessary. Then students examine patients on the topic of the lesson and start detailed discussion of the patients with the teacher. The discussion is followed by the end-level tests. In the end of the lesson the teacher summarizes students’ work on the topic.
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