Second degree AV block (patient information)

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Second degree AV block


What are the symptoms?

What are the causes?

Who is at highest risk?


When to seek urgent medical care?

Treatment options

Where to find medical care for Second degree AV block?


What to expect (Outlook/Prognosis)?

Possible complications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Elsaiey, MBBCH [2]


Second-degree AV block occurs when some electrical signals from the atria do not reach the ventricles, leading to dropped beats. More severe cases of second-degree AV block can turn into third-degree AV block.

What are the symptoms of Second degree AV block?

Second-degree heart block:

  • The electrical impulse may not reach the lower chambers of the heart.
  • The heart may miss a beat or beats and may be slow and irregular.
  • You may feel dizzy, faint, or have other symptoms.
  • This may be serious in some cases.

What causes Second degree AV block?

Heart block may be caused by:

  • Side effects of medicines. Heart block can be a side effect of digitalis, beta-blockers, calcium channel blockers, and other medicines.
  • A heart attack that damages the electrical system in the heart.
  • Heart diseases, such as heart valve disease and cardiac sarcoidosis.
  • Some infections, such as Lyme disease.
  • Heart surgery.

You may have heart block because you were born with it. You are more at risk for this if:

  • You have a heart defect.
  • Your mother has an autoimmune disease, such as lupus.

Who is at highest risk?

  • Common risk factors associated with second degree AV block include the following:
    • Intrinsic atrioventricular node disease
    • Myocarditis
    • Acute myocardial infarction
    • Prior cardiac surgery
    • Older age
    • Heart attack or coronary artery disease
    • Cardiomyopathy
    • Sarcoidosis
    • Lyme disease
    • High potassium levels
    • Severe hypothyroidism
    • Certain inherited neuromuscular diseases
    • Medicines that slow the heart rate
    • After open heart surgery


The cardiologist will talk to you about your medical history and the medicines you are taking. The cardiologist will also:

  • Do a complete physical exam. The provider will check you for signs of heart failure, such as swollen ankles and feet.
  • Do an ECG test to check the electrical signals in your heart.
  • You may need to wear a heart monitor for 24 to 48 hours or longer to check the electrical signals in your heart.

When to seek urgent medical care?

Call your provider if you feel:

  • Dizzy
  • Weak
  • Faint
  • Racing heart beat
  • Skipped heart beat
  • Chest pain

Call your provider if you have signs of heart failure:

  • Weakness
  • Swollen legs, ankles, or feet
  • Feel short of breath

Treatment options

Medications to avoid

Patients diagnosed with second degree AV block(except in patients with a functioning artificial pacemaker) should avoid using the following medications:

Where to find medical care for Second degree AV block?

Almost every emergency room can diagnose and refer the patients to the third parties who will make the decision for appropriate intervention. If a pacemaker is needed which is necessary for the majority of cases then a specialized cardiology/electrophysiology center is needed to place a duel chamber pacemaker.


If you have a pacemaker, you cannot be near strong magnetic fields. You need to let people know that you have a pacemaker.

  • DO NOT go through the usual security station at an airport, courthouse, or other place that requires people to walk through a security screening. Tell the security personnel you have a pacemaker and ask for an alternate type of security screening.
  • DO NOT get an MRI without telling the MRI technician about your pacemaker.

What to expect (Outlook/Prognosis)?

With regular monitoring and treatment, you should be able to keep up with most of your usual activities.

Possible complications

Heart block may increase the risk for:

  • Other kinds of heart rhythm problems (arrhythmias), such as atrial fibrillation. Talk to your provider about symptoms of other arrhythmias.
  • Heart attack.