Paroxysmal 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: Akash Daswaney, M.B.B.S[2]
Overview
The majority of patients with paroxysmal AV Block present with presyncope, syncope, with or without a prodrome or are asymptomatic.
History and Symptoms
- History of syncope, presyncope, duration of each episode, number of episodes, activities during the syncopal episode, aggravating or relieving factors, history of past medical illnesses, prodrome/ recovery phase description in terms of signs, symptoms and duration are important points to be addressed whilst taking a history of a syncope patient.
- A study of 341 syncope patients showed that the time between the first and last syncopal episode being less than 4 years, syncope during effort or supine position, a history of palpitations, convulsions or blurring of vision were important predictors of a cardiac syncope.
- Similarly, duration of prodrome > 10 seconds history of pallor, nausea, diaphoresis, dizziness, presyncope, abdominal discomfort and time between first and last syncopal episode being more than 4 years were important predictors of a neutrally mediated syncope.[1]
- Based on a detailed history, one can decide whether a cardiac syncope was secondary to a rhythm dysfunction, structural cause or ischemia related and would warrant a work up of an ECG, Holter monitoring, echocardiography, electrophysiologic study, or an exercise stress test. [1]
- Similarly, neutrally mediated syncope maybe vasovagal, situational, secondary to increased carotid sinus sensitivity or non classical and orthostatic hypotension may be due to a primary or secondary autonomic failure, secondary to drugs or hypovolemia. This may be further explored by a carotid sinus massage, tilt table testing, adenosine plasma levels or an adenosine triphosphate stimulation test."ESC Guidelines on Syncope (Diagnosis and Management of)".