Heart block

Introduction
Heart block is a problem that occurs with the
heart's electrical system. This system controls the
rate and rhythm of heartbeats. ("Rate" refers to
the number of times your heart beats in a minute.
"Rhythm" refers to the pattern of regular or
irregular pulses produced when the heart beats
over time.
 .
With each heartbeat, an electrical signal spreads
across the heart from the upper to the lower
chambers. As it travels, the signal causes the
heart to contract and pump blood. This process
repeats with each new heartbeat.
Heart block occurs if the electrical signal is
slowed or disrupted as it moves from the upper to
the lower chambers of the heart.
Types of heart block
First degree:-
1) AVB is a rhythm in which the electrical impulse
which leaves the SA node and travels through the atria,
AV node, Bundle of His to purkinjie fibres is slowed
down and takes longer than normal to arrive at its
destination. The normal PR interval is 0.12- 0.20
seconds. A 1 AVBT is greater than 0.20 seconds. The
cause ranges from coronary heart disease, inferior wall
MI's, hyperkalemia, congenital abnormalities, and
medications such as quinidine, digitalis, beta blockers,
and calcium channel blockers..
.
When the P-wave always precedes the QRS-
complex but the PR-interval is prolonged over 0.2
s, first-degree atrioventricular block is diagnosed.
Second degree heart block
In this type of heart block, electrical signals
between the atria and ventricles are slowed to a
large degree. Some signals don't reach the
ventricles.
Second-degree heart block is divided into two
types: Mobitz type I and Mobitz type II.
Mobitz Type I:-
also known as Wenckebach's block), This
arrhythmia is characterized by a progressive delay of
the conduction at the AV node, until the conduction is
completely blocked.
Mobitz Type II
In second-degree Mobitz type II heart block, some of
the electrical signals don't reach the ventricles.
On an EKG, the QRS wave follows the P wave at a
normal speed. Sometimes, though, the QRS wave is
missing (when a signal is blocked). It is characterized
by 2-4 P waves before each QRS.
Third-Degree Heart Block
In this type of heart block, none of the electrical
signals reach the ventricles. This type also is called
complete heart block or complete AV block.
All electrical conduction from the atria are blocked at
the AV junction, therefore, the atria and the ventricles
beat independently from each other.
On an EKG, the normal pattern is disrupted. The
P waves occur at a faster rate that isn't coordinated
with the QRS waves.
Complete heart block can result in
sudden cardiac arrest and death. A temporary
pacemaker may be used to keep the heart beating until
you get a long-term pacemaker.
Causes
Congenital-
congenital heart block occurs in babies whose mothers
have autoimmune diseases, such as lupus. People who
have these diseases make proteins called antibodies
that attack and damage the body's tissues or cells.
In pregnant women, antibodies can cross the placenta.
(The placenta is the organ that attaches the umbilical
cord to the mother's womb.) These proteins can
damage the baby's heart and lead to congenital heart
block.
Acquired
Many factors can cause acquired heart block.
Examples include:
Damage to the heart from a heart attack. This is the
most common cause of acquired heart block.
Coronary heart disease, also called coronary artery
disease.
Myocarditis (MI-o-kar-DI-tis), or inflammation of the
heart muscle.
Heart failure.
Rheumatic (roo-MAT-ik) fever.
Cardiomyopathy (KAR-de-o-mi-OP-a-the), or heart
muscle diseases.
Continua…
Exposure to toxic substances and taking certain
medicines—including digitalis, beta blockers, and
calcium channel blockers—also may cause heart
block.
heart block that occurs after a heart attack or surgery
may go away during recovery.
Other diseases also may raise the risk of heart block.
These include sarcoidosis and the degenerative muscle
disorders Lev's disease and Lenegre's disease.
Symptoms
First-degree heart block rarely causes symptoms.
Symptoms of second- and third-degree heart block
include:-
Fainting
Dizziness or light-headedness
Fatigue (tiredness)
Shortness of breath
Chest pain
Diagnostic evaluations
1) H/c- regarding family history and medical
history.
2) P/E- the doctor will ask regarding
 Check your pulse to find out how fast your heart
is beating
Check for swelling in your legs or feet, which
could be a sign of an enlarged heart or
heart failure
Look for signs of other diseases that could be
causing heart rate or rhythm problems (such as
coronary heart disease)
Contin….
3) ECG- to help diagnose heart block. This simple test
detects and records the heart's electrical activity.
4) Electrophysiology study- a thin, flexible wire is
passed through a vein in your groin (upper thigh) or
arm to your heart. The wire records your heart's
electrical signals.
5) Blood tests. Blood tests check the level of
substances in the blood, such as potassium or thyroid
hormone, that can increase your chances of having an
arrhythmia.
6)Chest x ray. A chest x ray is a painless test that
creates pictures of the structures in your chest, such as
your heart and lungs. This test can show whether the
heart is enlarged
Conti…
7) Echocardiography (echo) provides information
about the size and shape of your heart and how well
your heart chambers and valves are working.
transesophageal (tranz-ih-sof-uh-JEE-ul) echo, or TEE,
is a special type of echo that takes pictures of the back
of the heart through the esophagus (the passage
leading from your mouth to your stomach).
magnetic resonance imaging (MRI) and positron
emission tomography (PET) scanning of the heart.
8) Coronary angiography (an-jee-OG-ra-fee).
Coronary angiography uses dye and special x rays to
show the inside of your coronary (heart) arteries.
Conti….
9) Implantable loop recorder. This device detects
abnormal heart rhythms. Minor surgery is used to
place this device under the skin in the chest area.
Management
Medicines:-
1)The medicines used to slow a fast heart rate are
beta blockers (such as metoprolol and atenolol),
 calcium channel blockers (such as diltiazem and
verapamil), and digoxin (digitalis).
2) Antiarythmics -medicines used to restore an
abnormal heartbeat to a normal rhythm are
amiodarone, sotalol, flecainide, propafenone,
dofetilide, ibutilide, quinidine, procainamide, and
disopyramide.
3) Anticoagulants - Aspirin, warfarin (Coumadin®), and
heparin are commonly used blood thinners.
Conti….
4) arrhythmias are treated with a pacemaker. A
pacemaker is a small device that's placed under the
skin of your chest or abdomen to help control
abnormal heart rhythms.
5) Surgery –
CABG- This surgery improves blood supply to the
heart muscle.