Second degree AV block natural history, complications and prognosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Second degree AV block}} | {{Second degree AV block}} | ||
{{CMG}}; {{AE}} {{RT}} | {{CMG}}; {{AE}} {{Sara.Zand}} {{RT}} | ||
==Overview== | ==Overview== | ||
[[Second-degree AV nodal block]] commonly is seen in acute [[clinical]] settings including acute inferior wall [[myocardial infarction]], [[digitalis]] intoxication, [[myocarditis]], [[rheumatic fever]], after [[cardiac]] [[surgery]]. Chronic [[AV nodal block]] is seen in the setting of [[ischemic heart disease]], [[mesothelioma]] of the [[AV node]], [[atrial septal defect]], [[aortic valvular disease]], [[amyloidosis]], [[Reiter's syndrome]], [[mitral valve prolapse]], in [[healthy]] [[populations]], and in [[trained athletes]]. Mobitz II [[second degree Av block]] due to block inferior to the [[AV node]] ([[infra-Hisian]] structures) may progresses to [[complete heart block]]. Common complications associated with mobitz type 2 [[second degree AV block]] include progression to [[complete heart block]], [[syncope]], [[dizziness]], [[chest pain]], and [[death]]. | |||
Prognosis is generally good in [[patients]] with chronic [[second-degree AV nodal block]] without organic [[heart]] disease.However, in [[patients]] with [[heart ]] [[disease]] prognosis is poor and dependent on the severity of underlying [[heart]] disease. | |||
==Natural History== | ==Natural History== | ||
* | * [[Second-degree AV nodal block]] commonly is seen in acute [[clinical]] settings including acute inferior wall [[myocardial infarction]], [[digitalis]] intoxication, [[myocarditis]], [[rheumatic fever]], or after [[cardiac]] [[surgery]]. | ||
* Mobitz II second degree Av block | * Chronic [[AV nodal block]] is seen in the setting of [[ischemic heart disease]], [[mesothelioma]] of the [[AV node]], [[atrial septal defect]], [[aortic valvular disease]], [[amyloidosis]], [[Reiter's syndrome]], [[mitral valve prolapse]], in [[healthy]] [[populations]] , and in [[trained athletes]].<ref name="pmid7471363">{{cite journal |vauthors=Strasberg B, Amat-Y-Leon F, Dhingra RC, Palileo E, Swiryn S, Bauernfeind R, Wyndham C, Rosen KM |title=Natural history of chronic second-degree atrioventricular nodal block |journal=Circulation |volume=63 |issue=5 |pages=1043–9 |date=May 1981 |pmid=7471363 |doi=10.1161/01.cir.63.5.1043 |url=}}</ref>. | ||
* Mobitz II [[second degree Av block]] due to block inferior to the [[AV node]] ([[infra-Hisian]] structures) may progresses to [[complete heart block]].<ref name="pmid463945">{{cite journal |vauthors=Rodstein M, Wolloch L, Iuster Z |title=The natural history intraventricular conduction disturbances in the aged: an analysis of the developing second and third degree heart block with clinical pathological correlations |journal=Am. J. Med. Sci. |volume=277 |issue=2 |pages=179–88 |date=1979 |pmid=463945 |doi=10.1097/00000441-197903000-00006 |url=}}</ref>. | |||
==Complications== | ==Complications== | ||
::*Common complications associated with [[second degree AV block]] include: | |||
* [[Complete heart block]]<ref name="pmid6373268">{{cite journal |vauthors=Bexton RS, Camm AJ |title=Second degree atrioventricular block |journal=Eur. Heart J. |volume=5 Suppl A |issue= |pages=111–4 |date=March 1984 |pmid=6373268 |doi=10.1093/eurheartj/5.suppl_a.111 |url=}}</ref> | * [[Complete heart block]]<ref name="pmid6373268">{{cite journal |vauthors=Bexton RS, Camm AJ |title=Second degree atrioventricular block |journal=Eur. Heart J. |volume=5 Suppl A |issue= |pages=111–4 |date=March 1984 |pmid=6373268 |doi=10.1093/eurheartj/5.suppl_a.111 |url=}}</ref> | ||
* [[Stokes-Adams syndrome]] | * [[Stokes-Adams syndrome]] | ||
* [[Syncope]]<ref name="pmid29493981">{{cite journal |vauthors=Mangi MA, Jones WM, Napier L |title= |journal= |volume= |issue= |pages= |date= |pmid=29493981 |doi= |url=}}</ref> | * [[Syncope]]<ref name="pmid29493981">{{cite journal |vauthors=Mangi MA, Jones WM, Napier L |title= |journal= |volume= |issue= |pages= |date= |pmid=29493981 |doi= |url=}}</ref> | ||
*Dizziness | *[[Dizziness]] | ||
*Chest pain | *[[Chest pain]] | ||
*Death | *[[Death]] | ||
::* Common complications associated with [[pacemaker implantation]] can involve: | |||
* [[Pneumothorax]] | |||
* [[Cardiac tamponade]] | |||
* [[Death]]<ref name="pmid8160583">{{cite journal |vauthors=Pfeiffer D, Jung W, Fehske W, Korte T, Manz M, Moosdorf R, Lüderitz B |title=Complications of pacemaker-defibrillator devices: diagnosis and management |journal=Am. Heart J. |volume=127 |issue=4 Pt 2 |pages=1073–80 |date=April 1994 |pmid=8160583 |doi=10.1016/0002-8703(94)90090-6 |url=}}</ref>. | |||
*::After implantation, [[patients]] require generator changes, which carry a particularly high risk of [[infection]] and resultant [[endocarditis]].<ref name="pmid16492298">{{cite journal |vauthors=Bloom H, Heeke B, Leon A, Mera F, Delurgio D, Beshai J, Langberg J |title=Renal insufficiency and the risk of infection from pacemaker or defibrillator surgery |journal=Pacing Clin Electrophysiol |volume=29 |issue=2 |pages=142–5 |date=February 2006 |pmid=16492298 |doi=10.1111/j.1540-8159.2006.00307.x |url=}}</ref>. | |||
==Prognosis== | ==Prognosis== | ||
Prognosis is generally good in [[patients]] with chronic [[second-degree AV nodal block]] without organic [[heart]] disease. However, in [[patients]] with organic [[heart ]] [[disease]] prognosis is poor and dependent on the severity of underlying [[heart]] disease.<ref name="StrasbergAmat-Y-Leon1981">{{cite journal|last1=Strasberg|first1=B|last2=Amat-Y-Leon|first2=F|last3=Dhingra|first3=R C|last4=Palileo|first4=E|last5=Swiryn|first5=S|last6=Bauernfeind|first6=R|last7=Wyndham|first7=C|last8=Rosen|first8=K M|title=Natural history of chronic second-degree atrioventricular nodal block.|journal=Circulation|volume=63|issue=5|year=1981|pages=1043–1049|issn=0009-7322|doi=10.1161/01.CIR.63.5.1043}}</ref> | |||
==References== | ==References== | ||
Latest revision as of 04:22, 13 July 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Raviteja Guddeti, M.B.B.S. [3]
Overview
Second-degree AV nodal block commonly is seen in acute clinical settings including acute inferior wall myocardial infarction, digitalis intoxication, myocarditis, rheumatic fever, after cardiac surgery. Chronic AV nodal block is seen in the setting of ischemic heart disease, mesothelioma of the AV node, atrial septal defect, aortic valvular disease, amyloidosis, Reiter's syndrome, mitral valve prolapse, in healthy populations, and in trained athletes. Mobitz II second degree Av block due to block inferior to the AV node (infra-Hisian structures) may progresses to complete heart block. Common complications associated with mobitz type 2 second degree AV block include progression to complete heart block, syncope, dizziness, chest pain, and death. Prognosis is generally good in patients with chronic second-degree AV nodal block without organic heart disease.However, in patients with heart disease prognosis is poor and dependent on the severity of underlying heart disease.
Natural History
- Second-degree AV nodal block commonly is seen in acute clinical settings including acute inferior wall myocardial infarction, digitalis intoxication, myocarditis, rheumatic fever, or after cardiac surgery.
- Chronic AV nodal block is seen in the setting of ischemic heart disease, mesothelioma of the AV node, atrial septal defect, aortic valvular disease, amyloidosis, Reiter's syndrome, mitral valve prolapse, in healthy populations , and in trained athletes.[1].
- Mobitz II second degree Av block due to block inferior to the AV node (infra-Hisian structures) may progresses to complete heart block.[2].
Complications
- Common complications associated with second degree AV block include:
- Common complications associated with pacemaker implantation can involve:
- Pneumothorax
- Cardiac tamponade
- Death[5].
- After implantation, patients require generator changes, which carry a particularly high risk of infection and resultant endocarditis.[6].
Prognosis
Prognosis is generally good in patients with chronic second-degree AV nodal block without organic heart disease. However, in patients with organic heart disease prognosis is poor and dependent on the severity of underlying heart disease.[7]
References
- ↑ Strasberg B, Amat-Y-Leon F, Dhingra RC, Palileo E, Swiryn S, Bauernfeind R, Wyndham C, Rosen KM (May 1981). "Natural history of chronic second-degree atrioventricular nodal block". Circulation. 63 (5): 1043–9. doi:10.1161/01.cir.63.5.1043. PMID 7471363.
- ↑ Rodstein M, Wolloch L, Iuster Z (1979). "The natural history intraventricular conduction disturbances in the aged: an analysis of the developing second and third degree heart block with clinical pathological correlations". Am. J. Med. Sci. 277 (2): 179–88. doi:10.1097/00000441-197903000-00006. PMID 463945.
- ↑ 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.
- ↑ Mangi MA, Jones WM, Napier L. PMID 29493981. Missing or empty
|title=(help) - ↑ Pfeiffer D, Jung W, Fehske W, Korte T, Manz M, Moosdorf R, Lüderitz B (April 1994). "Complications of pacemaker-defibrillator devices: diagnosis and management". Am. Heart J. 127 (4 Pt 2): 1073–80. doi:10.1016/0002-8703(94)90090-6. PMID 8160583.
- ↑ Bloom H, Heeke B, Leon A, Mera F, Delurgio D, Beshai J, Langberg J (February 2006). "Renal insufficiency and the risk of infection from pacemaker or defibrillator surgery". Pacing Clin Electrophysiol. 29 (2): 142–5. doi:10.1111/j.1540-8159.2006.00307.x. PMID 16492298.
- ↑ Strasberg, B; Amat-Y-Leon, F; Dhingra, R C; Palileo, E; Swiryn, S; Bauernfeind, R; Wyndham, C; Rosen, K M (1981). "Natural history of chronic second-degree atrioventricular nodal block". Circulation. 63 (5): 1043–1049. doi:10.1161/01.CIR.63.5.1043. ISSN 0009-7322.