Third degree AV block causes: Difference between revisions

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__NOTOC__
__NOTOC__
{{Third degree AV block}}
{{Third degree AV block}}
{{CMG}}; {{AE}} {{CZ}}; {{RT}}
{{CMG}}; {{AE}} {{Soroush}} {{CZ}}; {{RT}}; {{Hilda}}


==Overview==
==Overview==
Many conditions can cause third degree heart block, but the most common cause is [[coronary ischemia]].  Progressive degeneration of the electrical conduction system of the heart can lead to third degree heart block.  This may be preceded by [[first degree AV block]], [[second degree AV block]], [[bundle branch block]], or [[bifascicular block]]. In addition, acute [[myocardial infarction]] may present with third degree AV block.
[[Atrioventricular block]] can be due to congenital or acquired causes. The latter are much more common form and include [[infectious]], [[inflammatory]], [[degenerative]], [[ischemic]], and [[iatrogenic]] causes. The  degenerative cause  are associated  with increased age, [[chronic]] [[hypertension]], and [[diabetes mellitus]]. [[Infectious]] cause of [[atrioventricular block]] such as [[lyme]] [[carditis]] may be reversible with [[medical therapy]].  Another reversible cause of [[atrioventricular block]] including [[ischemic]] [[inferior wall MI]] due to [[vagotonic]] effect should be considered.


Third degree heart block may also be [[congenital]] and has been linked to the presence of [[lupus erythematosus|lupus]] in the mother. It is thought that maternal antibodies may cross the [[placenta]] and attack the [[heart]] tissue during [[gestation]]. The cause of congenital third degree heart block in many patients is unknown.
==Causes==
The [[causes]] of third degree heart block can be broadly divided into [[acquired]] and [[congenital]]. Many of the [[acquired]] [[causes]] are the result of [[Infiltration (medical)|Infiltration]], [[fibrosis]], or loss of connection in the [[Conduction system disease|heart conduction system]] that can tend to develop [[heart block]].
===[[Congenital]] form of [[complete heart block]]===
* Usually occurs at [[Atrioventricular node|AVN]]. [[Patients]] are intially [[asymptomatic]] but may [[symptomatic]] during exertion. Mostly associated with [[maternal antibodies]] to [[SS-A]] (Ro) and [[SS-B]] (La).
 
===Common causes of acquired [[AV block ]] are as follows===
 
* '''[[Ischemia]] or [[infarction]]:'''
 
:* AV node (AVN) block associated with [[Myocardial infarction|inferior wall myocardial infarction]] (MI)
:*[[His-Purkinje fibers|His-Purkinje]] block associated with [[MI|anterior wall MI]]
 
*'''Drugs''':
 
:* Most of the [[antiarrhythmics]] like [[quinidine]], , [[disopyramide]],[[procainamide]] [[flecainide]], [[encainide]], [[Beta blockers|beta-blockers]] [[propafenone]], , [[amiodarone]], [[sotalol]], [[dofetilide]], [[ibutilide]], [[Calcium channel blocker|calcium channel blockers]], [[Digoxin]] and other cardiac [[glycosides]].
 
* '''Infectious disease:'''
 
:*[[Lyme borreliosis]] (mostly in endemic areas)
:*[[Myocarditis]]
:*[[Aspergillus]] [[myocarditis]]
:*[[Chagas disease]]: [[Trypanosoma cruzi infection|''Trypanosoma cruzi'' infection]]
:*[[Varicella-zoster virus|Varicella-zoster virus infection]]
:*Valve ring abscess
 
 
*'''Degenerative diseases:'''
 
:*[[Lenègre's disease|Lenègre disease]] (sclerodegenerative process involving only the conduction system)
:*[[Lev's disease]] (calcification of the conduction system and valves)
:*[[Noncompaction cardiomyopathy]]
:*[[Nail-patella syndrome]]
:*[[Mitochondrial myopathy]]
 
*
* '''Rheumatic diseases:'''
 
:*[[Ankylosing spondylitis]]
:*[[Reiter's syndrome|Reiter syndrome]]
:*[[Relapsing polychondritis]]
:*[[Rheumatoid arthritis]]
:*[[Rheumatic fever]]
:*[[Scleroderma]]
 
* '''Infiltrative pathologies:'''
 
:*[[Amyloidosis]]
:*[[Sarcoidosis]]
:*[[Malignant]] or [[benign tumors]]
:*[[Hodgkin's lymphoma|Hodgkin lymphoma]]
:*[[Multiple myeloma]]
 
*'''Neuromuscular disorders:'''
 
:*[[Becker's muscular dystrophy|Becker muscular dystrophy]]
:*[[Myotonic dystrophy]]
 
*
* '''Metabolic abnormality:'''
 
:*[[Hypoxia]]
:*[[Hyperkalemia]]
:*[[Hypothyroidism]]<ref name="OzcanOsmonov2012">{{cite journal|last1=Ozcan|first1=Kazim Serhan|last2=Osmonov|first2=Damirbek|last3=Erdinler|first3=Izzet|last4=Altay|first4=Servet|last5=Yildirim|first5=Ersin|last6=Turkkan|first6=Ceyhan|last7=Hasdemir|first7=Hakan|last8=Cakmak|first8=Nazmiye|last9=Alper|first9=Ahmet Taha|last10=Satilmis|first10=Seckin|last11=Gurkan|first11=Kadir|title=Atrioventricular block in patients with thyroid dysfunction: Prognosis after treatment with hormone supplementation or antithyroid medication|journal=Journal of Cardiology|volume=60|issue=4|year=2012|pages=327–332|issn=09145087|doi=10.1016/j.jjcc.2012.05.012}}</ref>
 
 
* '''Toxins:'''
 
:*[[Grayanotoxin]]:“Mad” honey
:*Natural cardiac [[glycosides]] such as oleandrin
 
* '''Bradycardia-related block'''
* '''Iatrogenic heart block'''
 
:*[[Aortic valve surgery - minimally invasive (patient information)|Aortic valve surgery]]
:*Septal alcohol ablation
:*[[Percutaneous coronary intervention]] (PCI) to the [[left anterior descending artery]]
:*[[Ablation]] of the slow or fast pathway of the [[AVN]]
:*[[Ablation]] of accessory pathways near [[AVN]]
 
===Life Threatening Causes===
Third degree heart block is a life-threatening condition and must be treated as such irrespective of the causes.  Life-threatening conditions  can result in death or permanent disability within 24 hours if left untreated.


==Causes==
===Common Causes===
===Common Causes===
* Acute ST elevation MI - [[Complete heart block]] occurs in 2.5% to 8% of patients.<ref name="pmid18274563">{{cite journal |author=Malla RR, Sayami A |title=In hospital complications and mortality of patients of inferior wall myocardial infarction with right ventricular infarction |journal=JNMA J Nepal Med Assoc |volume=46 |issue=167 |pages=99–102 |year=2007 |pmid=18274563 |doi= |url=}}</ref>
*[[Acute rheumatic fever]]
** Inferior ST elevation [[MI]]: [[AV block]] is more common in patients with inferior [[MI]]s (1/3rd of patients).
*[[Coronary ischemia]]
*** In 90% of patients the inferior wall is supplied by the [[RCA]] which gives off a branch to the [[AV node]].
*[[Myocardial infarction]] <ref name="pmid18274563">{{cite journal |author=Malla RR, Sayami A |title=In hospital complications and mortality of patients of inferior wall myocardial infarction with right ventricular infarction |journal=JNMA J Nepal Med Assoc |volume=46 |issue=167 |pages=99–102 |year=2007 |pmid=18274563 |doi= |url=}}</ref>
*** As a rule the [[AV block]] is transient and normal function returns within a week of the acute episode.
*[[Systemic lupus erythematosus]]
** Anterior ST elevation [[MI]]: [[AV block]] may be seen in up to 21%.
*[[Valvular heart disease]]
*** Incidence of [[second degree AV block]] and [[third degree AV block]] is 5 to 7%.
 
*** Block is the result of damage to the interventricular septum supplied by the [[LAD]].
 
*** There is damage to the bundle branches either in the form of bilateral bundle branch block or [[trifascicular block]].
 
*** [[RBBB]], [[RBBB]] + [[LAHB]], [[RBBB]] + [[LPHB]] or [[LBBB]] often appear before the development of [[AV block]].
===Medications inducing [[bradycardia ]] or [[conduction disorder]]===
*** The PR is normal or minimally prolonged before the onset of [[second degree AV block]] or [[third degree AV block]].
<br />
*** Although the [[AV block]] is usually transient, there is a relatively high incidence of recurrence or high-degree AV block after the acute event.
{| class="wikitable"
*** In addition to [[ischemia]], [[fibrosis]] and [[calcification]] of the summit of the ventricular septum that involve the branching part of the bundle branches, may play a role in the genesis of the conduction defect.
|+Medications that Can Induce/Exacerbate Bradycardia or Conduction Disorders<ref name=":0" />
*** It used to be thought that CAD was the most frequent cause of chronic [[complete AV block]], but it actually causes only 15% of cases.
!Anti-hypertensive
!Anti-arrhythmic
!Psychoactive
!Other
|-
|• Beta-Adrenergic Receptor Blockers
• [[Clonidine HCL|Clonidine]]  
 
• [[Methyldopa]]  
 
• Non-dihydropyridine calcium channel blockers


* Degenerative diseases
• [[Reserpine]]
** Sclerodegenerative disease of the bundle branches was first described by Lenegre.
|• [[Adenosine]]                                 .                                                                                      
** The pathologic process is called idiopathic bilateral bundle branch fibrosis and the heart block is called primary heart block.
• [[Amiodarone]]  
** This is the most common cause of chronic [[AV block]] (46%).
** Lev described similar degenerative lesions, which he referred to as sclerosis of the left side of the cardiac skeleton. There is progressive [[fibrosis]] and calcification of the mitral annulus, the central fibrous body, the pars membranacea, the base of the [[aorta]], and the summit of the muscular ventricular septum. Various portions of the [[His bundle]] or the bundle branches may be involved, resulting in [[AV block]].


* Hypertension
• [[Dronedarone]]  
** Chronic [[AV block]] in patients with [[HTN]] is thought to be due to [[CAD]] or sclerosis of the left side of the cardiac skeleton exacerbated by [[hypertension]].


* Diseases of the myocardium
• [[Flecainide]]  
** [[Acute rheumatic fever]]: PR prolongation is a common (25 to 95% of cases) sign in patients with [[acute rheumatic fever]]
*** Usually transient, disappears when the patient recovers
** [[Dilated cardiomyopathy]] results in various degrees of heart block are seen in 15% of patients
** [[HCM]]: 3% of patients with [[HCM]] will develop heart block


* Valvular heart disease
• [[Procainamide]]  
** Calcific [[aortic stenosis]] may be accompanied by chronic partial or complete AV block
** There is an extension of the calcification to involve the main bundle or its bifurcation, resulting in degeneration and necrosis of the conduction tissue
** May also occur in rheumatic mitral valve disease, but is less common
** Occasionally, massive calcification of the mitral annulus as an aging process may cause [[AV block]]
** May also be seen in [[bacterial endocarditis]], especially of the [[aortic valve]]


* Drugs
• [[Propafenone]]  
** [[Digoxin]] is one of the most common causes of reversible [[AV block]]
*** The ventricular response rate is more rapid than that due to organic lesions, and increased automaticity of the AV junctional pacemaker may be responsible.
** [[Quinidine]] and [[Procainamide]] may produce slight prolongation of the PR
** [[Beta blocker|β blockers]] may cause [[AV block]]
** [[Diltiazem]] and [[verapamil]] may cause AV conduction delay and [[PR interval]] prolongation


* Congenital
• [[Quinidine]]  
** Occurs in the absence of other evidence of organic heart disease
** Site is usually proximal to the bifurcation of the [[His bundle]], most often in the [[AV node]]
** Narrow [[QRS]] with a rate > 40 beats per minute
** Frequently seen in those with corrected [[transposition of the great vessels]], and occasionally in [[ASD]]s and [[Ebstein's anomaly]]<ref name="pmid20381087">{{cite journal |author=Lin A, Mahle WT, Frias PA, ''et al.'' |title=Early and delayed atrioventricular conduction block after routine surgery for congenital heart disease |journal=J. Thorac. Cardiovasc. Surg. |volume=140 |issue=1 |pages=158–60 |year=2010 |month=July |pmid=20381087 |doi=10.1016/j.jtcvs.2009.12.050 |url=}}</ref>


* Trauma
• [[Sotalol]]
** May be induced during open heart surgery in the area of AV conduction tissue<ref name="pmid20723650">{{cite journal |author=Godin M, Eltchaninoff H, Furuta A, ''et al.'' |title=Frequency of conduction disturbances after transcatheter implantation of an Edwards Sapien aortic valve prosthesis |journal=Am. J. Cardiol. |volume=106 |issue=5 |pages=707–12 |year=2010 |month=September |pmid=20723650 |doi=10.1016/j.amjcard.2010.04.029 |url=}}</ref>
|• [[Donepezil]]
** Seen in patients operated on for the correction of [[ASD]]<ref name="pmid23285170">{{cite journal |author=Chen Q, Cao H, Zhang GC, ''et al.'' |title=Atrioventricular block subsequent to intraoperative device closure atrial septal defect with transthoracic minimal invasion; a rare and serious complication |journal=PLoS ONE |volume=7 |issue=12 |pages=e52726 |year=2012 |pmid=23285170 |pmc=3532427 |doi=10.1371/journal.pone.0052726 |url=}}</ref>, [[VSD]]<ref name="pmid18727001">{{cite journal |author=Zhou T, Shen XQ, Zhou SH, ''et al.'' |title=Atrioventricular block: a serious complication in and after transcatheter closure of perimembranous ventricular septal defects |journal=Clin Cardiol |volume=31 |issue=8 |pages=368–71 |year=2008 |month=August |pmid=18727001 |doi=10.1002/clc.20243 |url=}}</ref>, [[tetralogy of Fallot]], and [[endocardial cushion defect]].
• [[Lithium]]  
** May be due to [[edema]], transient ischemia, or actual disruption of the conduction tissue. The block may therefore be permanent or transient.
 
** Also reported with both penetrating and non-penetrating trauma of the chest
• Opioid analgesics
 
• Phenothiazine antiemetics and antipsychotics
 
• [[Phenytoin]]  
 
• [[Selective serotonin reuptake inhibitor|Selective Serotonin Reuptake Inhibitor]]<nowiki/>s
 
• Tricyclic Antidepressants
|• Anesthetic Drugs [[Propofol|(propofol]])
• [[Cannabis (drug) detailed information|Cannabis]] • Digoxin
 
• [[Ivabradine]]  
 
• Muscle relaxants (e.g. [[succinylcholine]])
|}


===Causes by Organ System===
===Causes by Organ System===
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Acute rheumatic fever]], [[amyloidosis]], [[aspergillosis|aspergillosis myocarditis]], [[atrial septal defect]], [[bacterial endocarditis]], [[congenital heart block]],<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Congenital complete atrioventricular |block. | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC325472/ | publisher =  | date =  | accessdate = 21 August 2013 | |}}</ref>  [[coronary ischemia]], [[dilated cardiomyopathy]], [[Ebstein's anomaly]], [[endocardial cushion defect]],  [[hypertension]],<ref name="pmid18174773">{{cite journal |author=Lionakis N, Moyssakis I, Gialafos E, Dalianis N, Votteas V |title=Aortic dissection and third-degree atrioventricular block in a patient with a hypertensive crisis |journal=J Clin Hypertens (Greenwich) |volume=10 |issue=1 |pages=69–72 |year=2008 |month=January |pmid=18174773 |doi= |url=}}</ref> [[hypertrophic cardiomyopathy]],  [[hypertrophic cardiomyopathy alcohol septal ablation]],<ref name="pmid23363714">{{cite journal |author=Liu R, Qiao SB, Hu FH, Yang WX, Yuan JS |title=[Clinical features of five patients with delayed third degree atrioventricular block after ethanol septal ablation for hypertrophic obstructive cardiomyopathy] |language=Chinese |journal=Zhonghua Xin Xue Guan Bing Za Zhi |volume=40 |issue=12 |pages=1009–11 |year=2012 |month=December |pmid=23363714 |doi= |url=}}</ref> [[heart block|idiopathic heart block]],<ref name="pmid22068075">{{cite journal |author=Sykes JA, Lubega J, Ezetendu C, Verma R, O'Connor B, Kalyanaraman M |title=Asymptomatic complete atrioventricular block in a 13-year-old girl |journal=Pediatr Emerg Care |volume=27 |issue=11 |pages=1081–3 |year=2011 |month=November |pmid=22068075 |doi=10.1097/PEC.0b013e3182360674 |url=}}</ref><ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = |Idiopathic heart block: association with vitiligo, thyroid disease, pernicious anaemia, and diabetes mellitus. | url = |http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1675154/ | publisher =  | date =  | accessdate = 21 August 2013 }}</ref> [[idiopathic hypereosinophilic syndrome]], [[mitochondrial myopathy]], [[myocardial infarction]],<ref name="pmid18274563">||  {{cite journal |author=Malla RR, Sayami A |title=In hospital complications and mortality of patients of inferior wall |myocardial infarction with right ventricular infarction |journal=JNMA J Nepal Med Assoc |volume=46 |issue=167 |pages=99–102 |year=2007 |pmid=18274563 |doi= |url=}}</ref> [[myocarditis]], [[noncompaction cardiomyopathy]], [[tetralogy of fallot]], [[transposition of the great vessels]], [[valvular heart disease]], [[ventricular septal defect]]
|-
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
Line 84: Line 166:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Arsenic trioxide]], [[Beta-blocker]], [[calcium channel blocker]],<ref name="pmid18403171">{{cite journal |author=Wills BK, Liu JM, Wahl M |title=Third-degree AV block [from extended-release diltiazem ingestion in a nine-month-old |journal=J Emerg Med |volume=38 |issue=3 |pages=328–31 |year=2010 |month=April |pmid=18403171 |doi=10.1016/j.jemermed.2007.10.053 |url=}}</ref> [[cardiac glycosides]], [[cholinesterase inhibitor]], [[digitalis]], [[procainamide]], [[quinidine]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 92: Line 174:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Amyloidosis]], [[hyperthyroidism]],<ref name="pmid22257810">{{cite journal |author=Amasyalı B, Barçın C, Kılıç A |title=[Supra-His complete atrioventricular block in a patient with subclinical hyperthyroidism] |language=Turkish |journal=Turk Kardiyol Dern Ars |volume=39 |issue=8 |pages=693–6 |year=2011 |month=December |pmid=22257810 |doi= |url=}}</ref>
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 104: Line 186:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Erb's dystrophy]], [[Kearns-Sayre syndrome]], [[nail-patella syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Thalassemia major]]<ref name="pmid23056897">{{cite journal |author=Maleki AR, Nikyar B, Hosseini SM |title=Third-Degree Heart Block in Thalassemia major: A Case Report |journal=Iran J Pediatr |volume=22 |issue=2 |pages=260–4 |year=2012 |month=June |pmid=23056897 |pmc=3446065 |doi= |url=}}</ref>
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Cardiac surgery]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[aspergillosis|Aspergillosis myocarditis]], [[bacterial endocarditis]], [[Chagas disease]], [[diphtheria]],
[[lyme disease]],<ref name="pmid21125053">{{cite journal |author=Bhattacharya IS, Dweck M, Francis M |title=Lyme carditis: a |reversible cause of complete atrioventricular block |journal=J R Coll Physicians Edinb |volume=40 |issue=2 |pages=121–2 |year=2010 |month=June |pmid=21125053 |doi=10.4997/JRCPE.2010.207 |url=}}</ref><ref name="pmid20840915">{{cite journal |author=Wagner V, Zima E, Gellér L, Merkely B |title=[Acute atrioventricular block in chronic Lyme disease] |language=Hungarian |journal=Orv Hetil |volume=151 |issue=39 |pages=1585–90 |year=2010 |month=September |pmid=20840915 |doi=10.1556/OH.2010.28965 |url=}}</ref><ref name="pmid20464556">{{cite journal |author=Semmler D, Blank R, Rupprecht H |title=Complete AV block in Lyme carditis: an important differential diagnosis |journal=Clin Res Cardiol |volume=99 |issue=8 |pages=519–26 |year=2010 |month=August |pmid=20464556 |doi=10.1007/s00392-010-0152-8 |url=}}</ref> [[varicella zoster]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 124: Line 207:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[vagal tone|Enhanced vagal tone]], [[idiopathic hypereosinophilic syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Amyloidosis]], [[hemochromatosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 136: Line 219:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Hodgkin disease]], [[multiple myeloma]], [[tumor]]<ref name="pmid21892927">{{cite journal |author=Frikha Z, Abid L, Abid D, ''et al.'' |title=Cardiac tamponade and paroxysmal third-degree atrioventricular block revealing a primary cardiac non-Hodgkin large B-cell lymphoma of the right ventricle: a case report |journal=J Med Case Rep |volume=5 |issue= |pages=433 |year=2011 |pmid=21892927 |pmc=3180417 |doi=10.1186/1752-1947-5-433 |url=}}</ref><ref name="pmid20605278">{{cite journal |author=Houchaymi Z, Helou S, Ballout J |title=[Pericardial tamponade and third-degree atrioventricular block revealing a primary cardiac lymphoma] |language=French |journal=Rev Med Interne |volume=31 |issue=11 |pages=e4–6 |year=2010 |month=November |pmid=20605278 |doi=10.1016/j.revmed.2010.01.014 |url=}}</ref>
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 144: Line 227:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
| '''Overdose/Toxicity'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Alcohol intoxication]]<ref name="pmid22679160">{{cite journal |author=van Cleef AN, Schuurman MJ, Busari JO |title=Third-degree atrioventricular block in an adolescent following acute alcohol intoxication |journal=BMJ Case Rep |volume=2011 |issue= |pages= |year=2011 |pmid=22679160 |doi=10.1136/bcr.07.2011.4547 |url=}}</ref><ref name="pmid19918387">{{cite journal |author=Brvar M, Bunc M |title=High-degree atrioventricular block in acute ethanol poisoning: a case report |journal=Cases J |volume=2 |issue= |pages=8559 |year=2009 |pmid=19918387 |pmc=2769457 |doi=10.4076/1757-1626-2-8559 |url=}}</ref>
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 156: Line 239:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
| '''Renal/Electrolyte'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Hyperkalemia]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Amyloidosis]], [[ankylosing spondylitis]], [[Becker muscular dystrophy]], [[Churg-Strauss syndrome]],<ref name="pmid20979789">{{cite journal |author=Tian Z, Fang Q, Zhao DC, ''et al.'' |title=[The clinico-pathological manifestation of cardiac involvement in eosinophilic diseases] |language=Chinese |journal=Zhonghua Nei Ke Za Zhi |volume=49 |issue=8 |pages=684–7 |year=2010 |month=August |pmid=20979789 |doi= |url=}}</ref> [[degenerative diseases]], [[dermatomyositis]], [[Erb's dystrophy]], [[idiopathic hypereosinophilic syndrome]], [[muscular dystrophy]]<ref name="pmid23194837">{{cite journal |author=Facenda-Lorenzo M, Hernández-Afonso J, Rodríguez-Esteban M, de León-Hernández JC, Grillo-Pérez JJ |title=Cardiac Manifestations in Myotonic Dystrophy Type 1 Patients Followed Using a Standard Protocol in a Specialized Unit |journal=Rev Esp Cardiol |volume= |issue= |pages= |year=2012 |month=November |pmid=23194837 |doi=10.1016/j.recesp.2012.08.011 |url=}}</ref> [[myotonic muscular dystrophy]],  [[peroneal muscular atrophy]], [[Reiter's syndrome]], [[relapsing polychondritis]],[[sarcoidosis]], [[scleroderma]],<ref name="pmid20920962">{{cite journal |author=Femenía F, Arce M, Arrieta M |title=[Systemic sclerosis complicated with syncope and complete AV block] |language=Spanish; Castilian |journal=Medicina (B Aires) |volume=70 |issue=5 |pages=442–4 |year=2010 |pmid=20920962 |doi= |url=}}</ref> [[neonatal lupus erythematosus]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
Line 176: Line 259:
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"|[[Trauma]]<ref name="pmid22816548">{{cite journal |author=Thakar S, Chandra P, Pednekar M, Kabalkin C, Shani J |title=Complete heart block following a blow on the chest by a soccer ball: a rare manifestation of commotio cordis |journal=Ann Noninvasive Electrocardiol |volume=17 |issue=3 |pages=280–2 |year=2012 |month=July |pmid=22816548 |doi=10.1111/j.1542-474X.2012.00518.x |url=}}</ref><ref name="pmid21621364">{{cite journal |author=Portet N, Riu B, Bounes V, Minville V, Fourcade O |title=Left ventricular-right atrial communication with third-degree atrioventricular block after thoracic trauma |journal=J Emerg Med |volume=43 |issue=6 |pages=e385–8 |year=2012 |month=December |pmid=21621364 |doi=10.1016/j.jemermed.2010.11.059 |url=}}</ref>
|-
|-
|}
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===Causes in Alphabetical Order===
===Causes in Alphabetical Order===
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[Acute rheumatic fever]]
*[[Acute rheumatic fever]]
* [[Alcohol intoxication]]<ref name="pmid22679160">{{cite journal |author=van Cleef AN, Schuurman MJ, Busari JO |title=Third-degree atrioventricular block in an adolescent following acute alcohol intoxication |journal=BMJ Case Rep |volume=2011 |issue= |pages= |year=2011 |pmid=22679160 |doi=10.1136/bcr.07.2011.4547 |url=}}</ref><ref name="pmid19918387">{{cite journal |author=Brvar M, Bunc M |title=High-degree atrioventricular block in acute ethanol poisoning: a case report |journal=Cases J |volume=2 |issue= |pages=8559 |year=2009 |pmid=19918387 |pmc=2769457 |doi=10.4076/1757-1626-2-8559 |url=}}</ref>
*[[Alcohol intoxication]]<ref name="pmid22679160">{{cite journal |author=van Cleef AN, Schuurman MJ, Busari JO |title=Third-degree atrioventricular block in an adolescent following acute alcohol intoxication |journal=BMJ Case Rep |volume=2011 |issue= |pages= |year=2011 |pmid=22679160 |doi=10.1136/bcr.07.2011.4547 |url=}}</ref><ref name="pmid19918387">{{cite journal |author=Brvar M, Bunc M |title=High-degree atrioventricular block in acute ethanol poisoning: a case report |journal=Cases J |volume=2 |issue= |pages=8559 |year=2009 |pmid=19918387 |pmc=2769457 |doi=10.4076/1757-1626-2-8559 |url=}}</ref>
*[[Amyloidosis]]
*[[Amyloidosis]]
*[[Ankylosing spondylitis]]
*[[Ankylosing spondylitis]]
Line 193: Line 278:
*[[Calcium channel blocker]]<ref name="pmid18403171">{{cite journal |author=Wills BK, Liu JM, Wahl M |title=Third-degree AV block from extended-release diltiazem ingestion in a nine-month-old |journal=J Emerg Med |volume=38 |issue=3 |pages=328–31 |year=2010 |month=April |pmid=18403171 |doi=10.1016/j.jemermed.2007.10.053 |url=}}</ref>
*[[Calcium channel blocker]]<ref name="pmid18403171">{{cite journal |author=Wills BK, Liu JM, Wahl M |title=Third-degree AV block from extended-release diltiazem ingestion in a nine-month-old |journal=J Emerg Med |volume=38 |issue=3 |pages=328–31 |year=2010 |month=April |pmid=18403171 |doi=10.1016/j.jemermed.2007.10.053 |url=}}</ref>
*[[Cardiac glycosides]]
*[[Cardiac glycosides]]
*[[Cardiac surgery]]
*[[Chagas disease]]
*[[Chagas disease]]
*[[Cholinesterase inhibitor]]
*[[Cholinesterase inhibitor]]
Line 202: Line 288:
*[[Digitalis]]
*[[Digitalis]]
*[[Dilated cardiomyopathy]]
*[[Dilated cardiomyopathy]]
{{col-break|width=33%}}
*[[Diphtheria]]
*[[Diphtheria]]
*[[Ebstein's anomaly]]
*[[Ebstein's anomaly]]
Line 222: Line 309:
*[[Muscular dystrophy]]<ref name="pmid23194837">{{cite journal |author=Facenda-Lorenzo M, Hernández-Afonso J, Rodríguez-Esteban M, de León-Hernández JC, Grillo-Pérez JJ |title=Cardiac Manifestations in Myotonic Dystrophy Type 1 Patients Followed Using a Standard Protocol in a Specialized Unit |journal=Rev Esp Cardiol |volume= |issue= |pages= |year=2012 |month=November |pmid=23194837 |doi=10.1016/j.recesp.2012.08.011 |url=}}</ref>
*[[Muscular dystrophy]]<ref name="pmid23194837">{{cite journal |author=Facenda-Lorenzo M, Hernández-Afonso J, Rodríguez-Esteban M, de León-Hernández JC, Grillo-Pérez JJ |title=Cardiac Manifestations in Myotonic Dystrophy Type 1 Patients Followed Using a Standard Protocol in a Specialized Unit |journal=Rev Esp Cardiol |volume= |issue= |pages= |year=2012 |month=November |pmid=23194837 |doi=10.1016/j.recesp.2012.08.011 |url=}}</ref>
*[[Myocardial infarction]] <ref name="pmid18274563">{{cite journal |author=Malla RR, Sayami A |title=In hospital complications and mortality of patients of inferior wall myocardial infarction with right ventricular infarction |journal=JNMA J Nepal Med Assoc |volume=46 |issue=167 |pages=99–102 |year=2007 |pmid=18274563 |doi= |url=}}</ref>
*[[Myocardial infarction]] <ref name="pmid18274563">{{cite journal |author=Malla RR, Sayami A |title=In hospital complications and mortality of patients of inferior wall myocardial infarction with right ventricular infarction |journal=JNMA J Nepal Med Assoc |volume=46 |issue=167 |pages=99–102 |year=2007 |pmid=18274563 |doi= |url=}}</ref>
{{col-break|width=33%}}
*[[Myocarditis]]
*[[Myocarditis]]
*[[Myotonic muscular dystrophy]]
*[[Myotonic muscular dystrophy]]
Line 234: Line 322:
*[[Scleroderma]]<ref name="pmid20920962">{{cite journal |author=Femenía F, Arce M, Arrieta M |title=[Systemic sclerosis complicated with syncope and complete AV block] |language=Spanish; Castilian |journal=Medicina (B Aires) |volume=70 |issue=5 |pages=442–4 |year=2010 |pmid=20920962 |doi= |url=}}</ref>,
*[[Scleroderma]]<ref name="pmid20920962">{{cite journal |author=Femenía F, Arce M, Arrieta M |title=[Systemic sclerosis complicated with syncope and complete AV block] |language=Spanish; Castilian |journal=Medicina (B Aires) |volume=70 |issue=5 |pages=442–4 |year=2010 |pmid=20920962 |doi= |url=}}</ref>,
*[[Systemic lupus erythematosus]]
*[[Systemic lupus erythematosus]]
*[[Tetralogy of Fallot]]
*[[Tetralogy of fallot]]
*[[Thalassemia major]]<ref name="pmid23056897">{{cite journal |author=Maleki AR, Nikyar B, Hosseini SM |title=Third-Degree Heart Block in Thalassemia major: A Case Report |journal=Iran J Pediatr |volume=22 |issue=2 |pages=260–4 |year=2012 |month=June |pmid=23056897 |pmc=3446065 |doi= |url=}}</ref>
*[[Thalassemia major]]<ref name="pmid23056897">{{cite journal |author=Maleki AR, Nikyar B, Hosseini SM |title=Third-Degree Heart Block in Thalassemia major: A Case Report |journal=Iran J Pediatr |volume=22 |issue=2 |pages=260–4 |year=2012 |month=June |pmid=23056897 |pmc=3446065 |doi= |url=}}</ref>
*[[Transposition of the great vessels]]
*[[Transposition of the great vessels]]
Line 242: Line 330:
*[[Varicella zoster]]
*[[Varicella zoster]]
*[[Ventricular septal defect]]
*[[Ventricular septal defect]]
{{col-end}}


==References==
==References==
Line 250: Line 339:
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Up-To-Date]]


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Latest revision as of 04:47, 22 July 2021

Third degree AV block Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]; Raviteja Guddeti, M.B.B.S. [4]; Hilda Mahmoudi M.D., M.P.H.[5]

Overview

Atrioventricular block can be due to congenital or acquired causes. The latter are much more common form and include infectious, inflammatory, degenerative, ischemic, and iatrogenic causes. The degenerative cause are associated with increased age, chronic hypertension, and diabetes mellitus. Infectious cause of atrioventricular block such as lyme carditis may be reversible with medical therapy. Another reversible cause of atrioventricular block including ischemic inferior wall MI due to vagotonic effect should be considered.

Causes

The causes of third degree heart block can be broadly divided into acquired and congenital. Many of the acquired causes are the result of Infiltration, fibrosis, or loss of connection in the heart conduction system that can tend to develop heart block.

Congenital form of complete heart block

Common causes of acquired AV block are as follows

  • Drugs:
  • Infectious disease:


  • Degenerative diseases:
  • Rheumatic diseases:
  • Infiltrative pathologies:
  • Neuromuscular disorders:
  • Metabolic abnormality:


  • Toxins:
  • Bradycardia-related block
  • Iatrogenic heart block

Life Threatening Causes

Third degree heart block is a life-threatening condition and must be treated as such irrespective of the causes. Life-threatening conditions can result in death or permanent disability within 24 hours if left untreated.

Common Causes


Medications inducing bradycardia or conduction disorder


Medications that Can Induce/Exacerbate Bradycardia or Conduction Disorders[3]
Anti-hypertensive Anti-arrhythmic Psychoactive Other
• Beta-Adrenergic Receptor Blockers

• Clonidine

• Methyldopa

• Non-dihydropyridine calcium channel blockers

• Reserpine

• Adenosine .

• Amiodarone

• Dronedarone

• Flecainide

• Procainamide

• Propafenone

• Quinidine

• Sotalol

• Donepezil

• Lithium

• Opioid analgesics

• Phenothiazine antiemetics and antipsychotics

• Phenytoin

• Selective Serotonin Reuptake Inhibitors

• Tricyclic Antidepressants

• Anesthetic Drugs (propofol)

• Cannabis • Digoxin

• Ivabradine

• Muscle relaxants (e.g. succinylcholine)

Causes by Organ System

Cardiovascular Acute rheumatic fever, amyloidosis, aspergillosis myocarditis, atrial septal defect, bacterial endocarditis, congenital heart block,[4] coronary ischemia, dilated cardiomyopathy, Ebstein's anomaly, endocardial cushion defect, hypertension,[5] hypertrophic cardiomyopathy, hypertrophic cardiomyopathy alcohol septal ablation,[6] idiopathic heart block,[7][4] idiopathic hypereosinophilic syndrome, mitochondrial myopathy, myocardial infarction,[2] myocarditis, noncompaction cardiomyopathy, tetralogy of fallot, transposition of the great vessels, valvular heart disease, ventricular septal defect
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Arsenic trioxide, Beta-blocker, calcium channel blocker,[8] cardiac glycosides, cholinesterase inhibitor, digitalis, procainamide, quinidine
Ear Nose Throat No underlying causes
Endocrine Amyloidosis, hyperthyroidism,[9]
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic Erb's dystrophy, Kearns-Sayre syndrome, nail-patella syndrome
Hematologic Thalassemia major[10]
Iatrogenic Cardiac surgery
Infectious Disease Aspergillosis myocarditis, bacterial endocarditis, Chagas disease, diphtheria,

lyme disease,[11][12][13] varicella zoster

Musculoskeletal/Orthopedic No underlying causes
Neurologic Enhanced vagal tone, idiopathic hypereosinophilic syndrome
Nutritional/Metabolic Amyloidosis, hemochromatosis
Obstetric/Gynecologic No underlying causes
Oncologic Hodgkin disease, multiple myeloma, tumor[14][15]
Ophthalmologic No underlying causes
Overdose/Toxicity Alcohol intoxication[16][17]
Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte Hyperkalemia
Rheumatology/Immunology/Allergy Amyloidosis, ankylosing spondylitis, Becker muscular dystrophy, Churg-Strauss syndrome,[18] degenerative diseases, dermatomyositis, Erb's dystrophy, idiopathic hypereosinophilic syndrome, muscular dystrophy[19] myotonic muscular dystrophy, peroneal muscular atrophy, Reiter's syndrome, relapsing polychondritis,sarcoidosis, scleroderma,[20] neonatal lupus erythematosus
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous Trauma[21][22]

Third degree AV block causes developed by WikiDoc.org

Causes in Alphabetical Order

References

  1. ↑ Ozcan, Kazim Serhan; Osmonov, Damirbek; Erdinler, Izzet; Altay, Servet; Yildirim, Ersin; Turkkan, Ceyhan; Hasdemir, Hakan; Cakmak, Nazmiye; Alper, Ahmet Taha; Satilmis, Seckin; Gurkan, Kadir (2012). "Atrioventricular block in patients with thyroid dysfunction: Prognosis after treatment with hormone supplementation or antithyroid medication". Journal of Cardiology. 60 (4): 327–332. doi:10.1016/j.jjcc.2012.05.012. ISSN 0914-5087.
  2. ↑ 2.0 2.1 2.2 Malla RR, Sayami A (2007). "In hospital complications and mortality of patients of inferior wall myocardial infarction with right ventricular infarction". JNMA J Nepal Med Assoc. 46 (167): 99–102. PMID 18274563.
  3. ↑
  4. ↑ 4.0 4.1 4.2 4.3 "Congenital complete atrioventricular". Retrieved 21 August 2013. Text "block. " ignored (help)
  5. ↑ 5.0 5.1 Lionakis N, Moyssakis I, Gialafos E, Dalianis N, Votteas V (2008). "Aortic dissection and third-degree atrioventricular block in a patient with a hypertensive crisis". J Clin Hypertens (Greenwich). 10 (1): 69–72. PMID 18174773. Unknown parameter |month= ignored (help)
  6. ↑ 6.0 6.1 Liu R, Qiao SB, Hu FH, Yang WX, Yuan JS (2012). "[Clinical features of five patients with delayed third degree atrioventricular block after ethanol septal ablation for hypertrophic obstructive cardiomyopathy]". Zhonghua Xin Xue Guan Bing Za Zhi (in Chinese). 40 (12): 1009–11. PMID 23363714. Unknown parameter |month= ignored (help)
  7. ↑ 7.0 7.1 Sykes JA, Lubega J, Ezetendu C, Verma R, O'Connor B, Kalyanaraman M (2011). "Asymptomatic complete atrioventricular block in a 13-year-old girl". Pediatr Emerg Care. 27 (11): 1081–3. doi:10.1097/PEC.0b013e3182360674. PMID 22068075. Unknown parameter |month= ignored (help)
  8. ↑ 8.0 8.1 Wills BK, Liu JM, Wahl M (2010). "Third-degree AV block [from extended-release diltiazem ingestion in a nine-month-old". J Emerg Med. 38 (3): 328–31. doi:10.1016/j.jemermed.2007.10.053. PMID 18403171. Unknown parameter |month= ignored (help)
  9. ↑ 9.0 9.1 Amasyalı B, Barçın C, Kılıç A (2011). "[Supra-His complete atrioventricular block in a patient with subclinical hyperthyroidism]". Turk Kardiyol Dern Ars (in Turkish). 39 (8): 693–6. PMID 22257810. Unknown parameter |month= ignored (help)
  10. ↑ 10.0 10.1 Maleki AR, Nikyar B, Hosseini SM (2012). "Third-Degree Heart Block in Thalassemia major: A Case Report". Iran J Pediatr. 22 (2): 260–4. PMC 3446065. PMID 23056897. Unknown parameter |month= ignored (help)
  11. ↑ 11.0 11.1 Bhattacharya IS, Dweck M, Francis M (2010). "Lyme carditis: a". J R Coll Physicians Edinb. 40 (2): 121–2. doi:10.4997/JRCPE.2010.207. PMID 21125053. Text "reversible cause of complete atrioventricular block " ignored (help); Unknown parameter |month= ignored (help)
  12. ↑ 12.0 12.1 Wagner V, Zima E, Gellér L, Merkely B (2010). "[Acute atrioventricular block in chronic Lyme disease]". Orv Hetil (in Hungarian). 151 (39): 1585–90. doi:10.1556/OH.2010.28965. PMID 20840915. Unknown parameter |month= ignored (help)
  13. ↑ 13.0 13.1 Semmler D, Blank R, Rupprecht H (2010). "Complete AV block in Lyme carditis: an important differential diagnosis". Clin Res Cardiol. 99 (8): 519–26. doi:10.1007/s00392-010-0152-8. PMID 20464556. Unknown parameter |month= ignored (help)
  14. ↑ 14.0 14.1 Frikha Z, Abid L, Abid D; et al. (2011). "Cardiac tamponade and paroxysmal third-degree atrioventricular block revealing a primary cardiac non-Hodgkin large B-cell lymphoma of the right ventricle: a case report". J Med Case Rep. 5: 433. doi:10.1186/1752-1947-5-433. PMC 3180417. PMID 21892927.
  15. ↑ 15.0 15.1 Houchaymi Z, Helou S, Ballout J (2010). "[Pericardial tamponade and third-degree atrioventricular block revealing a primary cardiac lymphoma]". Rev Med Interne (in French). 31 (11): e4–6. doi:10.1016/j.revmed.2010.01.014. PMID 20605278. Unknown parameter |month= ignored (help)
  16. ↑ 16.0 16.1 van Cleef AN, Schuurman MJ, Busari JO (2011). "Third-degree atrioventricular block in an adolescent following acute alcohol intoxication". BMJ Case Rep. 2011. doi:10.1136/bcr.07.2011.4547. PMID 22679160.
  17. ↑ 17.0 17.1 Brvar M, Bunc M (2009). "High-degree atrioventricular block in acute ethanol poisoning: a case report". Cases J. 2: 8559. doi:10.4076/1757-1626-2-8559. PMC 2769457. PMID 19918387.
  18. ↑ 18.0 18.1 Tian Z, Fang Q, Zhao DC; et al. (2010). "[The clinico-pathological manifestation of cardiac involvement in eosinophilic diseases]". Zhonghua Nei Ke Za Zhi (in Chinese). 49 (8): 684–7. PMID 20979789. Unknown parameter |month= ignored (help)
  19. ↑ 19.0 19.1 Facenda-Lorenzo M, Hernández-Afonso J, Rodríguez-Esteban M, de León-Hernández JC, Grillo-Pérez JJ (2012). "Cardiac Manifestations in Myotonic Dystrophy Type 1 Patients Followed Using a Standard Protocol in a Specialized Unit". Rev Esp Cardiol. doi:10.1016/j.recesp.2012.08.011. PMID 23194837. Unknown parameter |month= ignored (help)
  20. ↑ 20.0 20.1 Femenía F, Arce M, Arrieta M (2010). "[Systemic sclerosis complicated with syncope and complete AV block]". Medicina (B Aires) (in Spanish; Castilian). 70 (5): 442–4. PMID 20920962.
  21. ↑ 21.0 21.1 Thakar S, Chandra P, Pednekar M, Kabalkin C, Shani J (2012). "Complete heart block following a blow on the chest by a soccer ball: a rare manifestation of commotio cordis". Ann Noninvasive Electrocardiol. 17 (3): 280–2. doi:10.1111/j.1542-474X.2012.00518.x. PMID 22816548. Unknown parameter |month= ignored (help)
  22. ↑ 22.0 22.1 Portet N, Riu B, Bounes V, Minville V, Fourcade O (2012). "Left ventricular-right atrial communication with third-degree atrioventricular block after thoracic trauma". J Emerg Med. 43 (6): e385–8. doi:10.1016/j.jemermed.2010.11.059. PMID 21621364. Unknown parameter |month= ignored (help)


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