Paroxysmal AV Block Differential Diagnosis: Difference between revisions

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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[1st Degree AV Block ]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[1st Degree AV Block ]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Associated with persistently prolonged PR interval with or without narrow QRS complexes. Not associated with periods of asystole.
| style="padding: 5px 5px; background: #F5F5F5;" | P waves associated with 1:1 atrioventricular conduction and a PR interval >200 ms (this is more accurately defined as atrioventricular delay because no P waves are blocked) <ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710  }} </ref>
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[2nd Degree AV Block]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[2nd Degree AV Block]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Mobitz type 1 is associated with progressively prolonged PR interval till one p wave does not conduct a QRS complex and group beating. Mobitz type 2 is associated with an episodic and unpredictable absence of conduction.  
| style="padding: 5px 5px; background: #F5F5F5;" |   P waves with a constant rate (<100 bpm) where atrioventricular conduction is present but not 1:1. '''Mobitz Type 1''': P waves with a constant rate (<100 bpm) with a periodic single nonconducted P wave associated with P waves before and after the nonconducted P wave with inconstant PR intervals. '''Mobitz Type 2''' :  P waves with a constant rate (< 100 bpm) with a periodic single nonconducted P wave associated with other P waves before and after the nonconducted P wave with constant PR intervals (excluding 2:1 atrioventricular block) <ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710  }} </ref>
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[3rd Degree AV Block]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[3rd Degree AV Block]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Complete dissociation between P and QRS complexes. Narrow or wide junctional or escape rhythms may be present. May present with syncope, asystole and sudden cardiac death.  
| style="padding: 5px 5px; background: #F5F5F5;" | No evidence of atrioventricular conduction. <ref name="pmid30412710">{{cite journal| author=Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR | display-authors=etal| title=2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. | journal=J Am Coll Cardiol | year= 2019 | volume= 74 | issue= 7 | pages= 932-987 | pmid=30412710 | doi=10.1016/j.jacc.2018.10.043 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30412710  }} </ref>
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Atrial Fibrillation]]'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Atrial Fibrillation]]'''
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| style="padding: 5px 5px; background: #DCDCDC;" | '''Others'''
| style="padding: 5px 5px; background: #DCDCDC;" | '''Others'''
| style="padding: 5px 5px; background: #F5F5F5;" |Atrial Flutter,Subclavian Steal syndrome, Vertebrobasilar Transient Ischemic Attacks, Sick Sinus Syndrome, Psychogenic Pseudosyncope, Psychogenic Non epileptic Seizures.  
| style="padding: 5px 5px; background: #F5F5F5;" | Atrial Flutter,Subclavian Steal syndrome, Vertebrobasilar Transient Ischemic Attacks, Sick Sinus Syndrome, Psychogenic Pseudosyncope, Psychogenic Non epileptic Seizures.  
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{{cite web |url=https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Syncope-Guidelines-on-Diagnosis-and-Management-of |title=ESC Guidelines on Syncope (Diagnosis and Management of) |format= |work= |accessdate=}}
{{cite web |url=https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Syncope-Guidelines-on-Diagnosis-and-Management-of |title=ESC Guidelines on Syncope (Diagnosis and Management of) |format= |work= |accessdate=}}

Revision as of 17:54, 25 June 2020

Disease Findings
Vasaovagal Syncope Occurs secondary to emotional distress, prolonged standing, painful stimuli. Seen more in women and may be diagnosed by tilt table testing. Not associated with periods of asystole.
Situational Syncope Due to cardioinhibitory and vasopressor mechanisms. Syncope may be associated with cough, micturition and defecation. Not associated with periods of asystole.
Carotid Sinus hypersensitivity Common causes of unexplained syncope in individuals more than 40 years of age. Syncope may be associated with wearing shirts with tight collars. Not associated with periods of asystole.
Aortic Stenosis Presents with syncope, angina and dyspnea on exertion. Not associated with periods of asystole but may show features of left ventricular hypertrophy. On Physical examination,pulsus parvus et tardus may be noted and a systolic click followed by a crescendo decrescendo murmur may be heard over the aortic area.
Hypertrophic Cardiomyopathy Hypertrophic Cardiomyopathy – Common cause of sudden cardiac death in adolescents during physical activity. Family history is often present. Not associated with periods of asystole.
1st Degree AV Block P waves associated with 1:1 atrioventricular conduction and a PR interval >200 ms (this is more accurately defined as atrioventricular delay because no P waves are blocked) [1]
2nd Degree AV Block P waves with a constant rate (<100 bpm) where atrioventricular conduction is present but not 1:1. Mobitz Type 1: P waves with a constant rate (<100 bpm) with a periodic single nonconducted P wave associated with P waves before and after the nonconducted P wave with inconstant PR intervals. Mobitz Type 2 : P waves with a constant rate (< 100 bpm) with a periodic single nonconducted P wave associated with other P waves before and after the nonconducted P wave with constant PR intervals (excluding 2:1 atrioventricular block) [1]
3rd Degree AV Block No evidence of atrioventricular conduction. [1]
Atrial Fibrillation May present with syncope, presyncope, lightheadedness or palpitations. Associated with irregular RR intervals and absence of clearly defined P waves.
Congenital long QT syndrome/ Torsade de pointes Associated with electrolyte abnormalities such as hypokalemia, hypomagnesemia, hypocalcemia or congenital conditions such as Jervell- Lange- Nielsen Syndrome and Romano ward Syndrome which may degenerate into a life threatening polymorphic ventricular tachycardia.
Seizures May be associated with generalized tonic clonic movements, tongue bite, bowel or bladder incontinence, a post ictal state and Todd’s paralysis. Following a loss of consciousness, there is a delayed recovery time.
Others Atrial Flutter,Subclavian Steal syndrome, Vertebrobasilar Transient Ischemic Attacks, Sick Sinus Syndrome, Psychogenic Pseudosyncope, Psychogenic Non epileptic Seizures.

"ESC Guidelines on Syncope (Diagnosis and Management of)".

  1. ↑ 1.0 1.1 1.2 Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR; et al. (2019). "2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society". J Am Coll Cardiol. 74 (7): 932–987. doi:10.1016/j.jacc.2018.10.043. PMID 30412710.
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