Second degree AV block history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Overview
Patients with second degree AV block are asymptomatic. Some patients may present with symptoms of reduced cardiac output. Symptoms include dizziness, fatigue, presyncope or syncope, and light headedness.
History
- History from patients with second degree AV block should involve asking about the following:[1][2]
- Congenital cardiac disease
- Current heart condition
- Recent or previous cardiac procedures
- History of medications
Symptoms
- Mobitz type 1 second degree AV block (Wenckebach) is often asymptomatic and can be seen in active, healthy patients without known heart [[disease.[3][4]
- Mobitz type 1 second degree AV block (Wenckebach) may occur during exercise causing exertional intolerance or dizziness, syncope.
- In patients with intermittent atrioventricular block leading syncope, initial evaluation including resting ECG, physical exam, echocardiography may be normal.
- Intermittent episodes of the atrioventricular block may be found with long-term monitoring.
- It was identified that in patients with syncope and evidence of bundle branch block or bifascicular block in resting ECG, there was 61% His Purkinje conduction abnormalities in electrophysiologic study.
- Symptoms in patients with an atrioventricular block that conducts in a 2:1 pattern include fatigue and dizziness particularly if it persists during exertion.
- If the sinus rate is slow and only a few beats are conducted, there may be a significantly reduced cardiac output.
- Common symptoms in such patients include:[5][6]
Second-degree atrioventricular block type I (Wenckebach) is often asymptomatic and seen in active, healthy patients with no history of heart disease. However, if occurring frequently or during exercise, it can cause symptoms of exertional intolerance or dizziness. Patients who present with complaints of syncope and have a negative initial workup such as a negative physical examination, ECG, and echocardiogram are sometimes found to have intermittent episodes of atrioventricular block with long-term monitoring.S6.2-5–S6.2-7 Intermittent complete atrioventricular block causing syncope or presyncope is more typically seen in patients with underlying heart disease or an underlying bundle branch block at baseline but can also be seen in patients with no baseline heart disease or evident conduction abnormalities. One study found that 8% of syncope patients with a normal ECG and echocardiogram had paroxysmal idiopathic atrioventricular block with no identifiable underlying cause.S6.2-5 Other studies evaluating patients with syncope and underlying bundle branch block or bifascicular block found that 61% had significant, clinically relevant His Purkinje conduction abnormalities identified at EPS.S6.2-8,S6.2-9 Patients with atrioventricular block that conducts in a 2:1 pattern can also have symptoms of fatigue and dizziness particularly if it persists during exertion.
References
- ↑ Zeppilli P, Fenici R, Sassara M, Pirrami MM, Caselli G (September 1980). "Wenckebach second-degree A-V block in top-ranking athletes: an old problem revisited". Am. Heart J. 100 (3): 281–94. doi:10.1016/0002-8703(80)90140-4. PMID 7405798.
- ↑ "StatPearls". 2020. PMID 29083636.
- ↑ Meimoun P, Zeghdi R, D'Attelis N, Berrebi A, Braunberger E, Deloche A; et al. (2002). "Frequency, predictors, and consequences of atrioventricular block after mitral valve repair". Am J Cardiol. 89 (9): 1062–6. doi:10.1016/s0002-9149(02)02276-2. PMID 11988196.
- ↑ Mangi MA, Jones WM, Napier L. PMID 29493981. Missing or empty
|title=(help) - ↑ Bexton RS, Camm AJ (March 1984). "Second degree atrioventricular block". Eur. Heart J. 5 Suppl A: 111–4. doi:10.1093/eurheartj/5.suppl_a.111. PMID 6373268.
- ↑ Wogan JM, Lowenstein SR, Gordon GS (1993). "Second-degree atrioventricular block: Mobitz type II". J Emerg Med. 11 (1): 47–54. doi:10.1016/0736-4679(93)90009-v. PMID 8445186.