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{{CMG}}; {{AE}}{{Akash}}
{{CMG}}; {{AE}}{{Akash}}


{{SK}}  
{{SK}} [[idiopathic paroxysmal AV block]], [[extrinsic vagal paroxysmal AV block]], [[extrinsic idiopathic paroxysmal AV block]], [[Paroxysmal Atrio-Ventricular block]], [[Paroxysmal Atrioventricular block]], [[intrinsic paroxysmal AV block]], [[idiopathic paroxysmal Atrioventricular block]], [[idiopathic paroxysmal Atrio-Ventricular block]], [[extrinsic vagal paroxysmal Atrioventricular block]], [[extrinsic vagal paroxysmal Atrio-Ventricular block]], [[extrinsic idiopathic paroxysmal Atrio-Ventricular block]], [[extrinsic idiopathic paroxysmal Atrioventricular block]], [[Paroxysmal av block]], [[extrinsic vagal paroxysmal av block]], [[extrinsic idiopathic paroxysmal av block]], [[Paroxysmal atrio-ventricular block]], [[Paroxysmal atrioventricular block]], [[intrinsic paroxysmal av block]], [[idiopathic paroxysmal atrioventricular block]], [[idiopathic paroxysmal atrio-ventricular block]], [[extrinsic vagal paroxysmal etrioventricular block]], [[extrinsic vagal paroxysmal atrio-ventricular block]], [[extrinsic idiopathic paroxysmal atrio-ventricular block]], [[extrinsic idiopathic paroxysmal atrioventricular block]]


==[[Paroxysmal AV block overview|Overview]]==
==[[Paroxysmal AV block overview|Overview]]==
*Paroxysmal AV block is defined as a delayed escape rhythm which repetitively blocks conduction from the atria to the ventricles, thereby causing syncope, conduction defects such as asystole and sudden cardiac death.
*It may or may not be associated with Phase 3 or Phase 4 conduction defects.
*It may be due to an increased vagal tone, innately low adenosine levels or an intrinsic conduction defect, all of which lead to different ECG presentations.
*Insufficient data is available regarding the exact etiology, diagnostic study of choice and treatment of paroxysmal AV blocks.
*It can be thought of more as a disease of exclusion. However,efforts must be made to have a standardized approach to such patients.


==[[Paroxysmal AV Block Historical Perspective|Historical Perspective]]==
==[[Paroxysmal AV Block Historical Perspective|Historical Perspective]]==
[[Paroxysmal AV Block Famous cases|Famous cases]]


==[[Paroxysmal AV block classification|Classification]]==
==[[Paroxysmal AV block classification|Classification]]==


[[Paroxysmal AV Block Based on Cause| Based on Cause]]
==[[Paroxysmal AV block pathophysiology|Pathophysiology]]==
 
==[[Paroxysmal AV block Causes|Causes]]==


==[[Paroxysmal AV block pathophysiology|Pathophysiology]]==
==[[Paroxysmal AV block Differentiating Paroxysmal AV Block from other Diseases |Differentiating Paroxysmal AV Block from other Diseases]]==


[[Paroxysmal AV Block Intrinsic AV Block|Intrinsic AV Block]] | [[Paroxysmal AV Block Extrinsic Vagal AV Block|Extrinsic Vagal AV Block]] | [[Paroxysmal AV Block Extrinsic Idiopathic AV Block|Extrinsic Idiopathic AV Block]]
==[[Paroxysmal AV block epidemiology and Demographics |Epidemiology and Demographics]]==


==[[Paroxysmal AV block epidemiology and Etiology |Epidemiology and Etiology]]==
==[[Paroxysmal AV block Risk Factors|Risk Factors]]==
[[Paroxysmal AV Block Epidemiology|Epidemiology]] | [[Paroxysmal AV Block Etiology|Etiology]]


{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
==[[Paroxysmal AV block Screening|Screening]]==
|+
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Vasaovagal Syncope ]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | 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.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Situational Syncope ]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | Due to cardioinhibitory and vasopressor mechanisms. Syncope may be associated with cough, micturition and defecation. Not associated with periods of asystole.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Carotid Sinus hypersensitivity]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | 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.
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''[[Aortic Stenosis ]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |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.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Hypertrophic Cardiomyopathy ]]'''
| style="padding: 5px 5px; background: #F5F5F5;" |Hypertrophic Cardiomyopathy – Common cause of sudden cardiac death in adolescents during physical activity. Family history is often present. Not associated with periods of asystole.
|-
| 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: #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: #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: #DCDCDC;" | '''[[Atrial Fibrillation]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | May present with syncope, presyncope, lightheadedness or palpitations. Associated with irregular RR intervals and absence of clearly defined P waves.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Congenital long QT syndrome/ Torsade de pointes ]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | 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.
|-
| style="padding: 5px 5px; background: #DCDCDC;" | '''[[Seizures]]'''
| style="padding: 5px 5px; background: #F5F5F5;" | 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.
|-
| 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.
|-
|}
{{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=}}


==[[Paroxysmal AV Block Natural History, Complications and Prognosis|Natural History, Complications and Prognosis]]==
==[[Paroxysmal AV Block Natural History, Complications and Prognosis|Natural History, Complications and Prognosis]]==


==[[Paroxysmal AV block Diagnosis|Diagnosis]]==
==Diagnosis==
 
[[Paroxysmal AV block diagnostic study of choice|Diagnostic study of choice]] | [[Paroxysmal AV block history and symptoms|History and Symptoms]] | [[Paroxysmal AV block physical examination|Physical Examination]] | [[Paroxysmal AV block laboratory findings|Laboratory Findings]] | [[Paroxysmal AV block electrocardiogram|Electrocardiogram]] | [[Paroxysmal AV block x ray|X-Ray Findings]] | [[Paroxysmal AV block echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[Paroxysmal AV block CT scan|CT-Scan Findings]] | [[Paroxysmal AV block MRI|MRI Findings]] | [[Paroxysmal AV block other imaging findings|Other Imaging Findings]] | [[Paroxysmal AV block other diagnostic studies|Other Diagnostic Studies]]
[[Paroxysmal AV block Initial Approach|Initial Approach]] | [[Paroxysmal AV block history and symptoms|History and Symptoms]] | [[Paroxysmal AV block Electrocardiogram|Electrocardiogram, Holter Monitoring, External Loop Recorder]] | [[Paroxysmal AV block Implantable Loop Recorder|Implantable Loop Recorder]] | [[Paroxysmal AV block Electrophysiologic studies|Electrophysiologic studies]] | [[Paroxysmal AV block Vagal Maneuvers :Carotid Sinus Massage and Tilt Table testing|Vagal Maneuvers,Carotid Sinus Massage and Tilt Table testing]] | [[Paroxysmal AV block Laboratory Findings and Stimulation tests|Laboratory Findings and Stimulation tests]] | [[Paroxysmal AV block Diagnostic Summary table | Diagnostic Summary Table]] |


==[[Paroxysmal AV block Treatment|Treatment]]==
==Treatment==
[[Paroxysmal AV block Cardiac Pacing| Cardiac Pacing]] |[[Paroxysmal AV block Treatment for Reflex Syncope|Treatment for Reflex Syncope]]|[[Paroxysmal AV block Theophylline |Theopylline]] |
[[Paroxysmal AV block medical therapy|Medical Therapy]] | [[Paroxysmal AV block interventions|Interventions]] | [[Paroxysmal AV block surgery|Surgery]] | [[Paroxysmal AV block primary prevention|Primary Prevention]] | [[Paroxysmal AV block secondary prevention|Secondary Prevention]] | [[Paroxysmal AV block cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Paroxysmal AV block future or investigational therapies|Future or Investigational Therapies]]


==Case Studies==
==Case Studies==
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[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Cardiovascular diseases]]
[[Category:Cardiovascular diseases]]
[[Category:Arrythmia]]
[[Category:Arrhythmia]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Disease]]
[[Category:Disease]]

Latest revision as of 19:51, 3 September 2020

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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]

Synonyms and keywords: idiopathic paroxysmal AV block, extrinsic vagal paroxysmal AV block, extrinsic idiopathic paroxysmal AV block, Paroxysmal Atrio-Ventricular block, Paroxysmal Atrioventricular block, intrinsic paroxysmal AV block, idiopathic paroxysmal Atrioventricular block, idiopathic paroxysmal Atrio-Ventricular block, extrinsic vagal paroxysmal Atrioventricular block, extrinsic vagal paroxysmal Atrio-Ventricular block, extrinsic idiopathic paroxysmal Atrio-Ventricular block, extrinsic idiopathic paroxysmal Atrioventricular block, Paroxysmal av block, extrinsic vagal paroxysmal av block, extrinsic idiopathic paroxysmal av block, Paroxysmal atrio-ventricular block, Paroxysmal atrioventricular block, intrinsic paroxysmal av block, idiopathic paroxysmal atrioventricular block, idiopathic paroxysmal atrio-ventricular block, extrinsic vagal paroxysmal etrioventricular block, extrinsic vagal paroxysmal atrio-ventricular block, extrinsic idiopathic paroxysmal atrio-ventricular block, extrinsic idiopathic paroxysmal atrioventricular block

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Paroxysmal AV Block from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice | History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X-Ray Findings | Echocardiography and Ultrasound | CT-Scan Findings | MRI Findings | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Interventions | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1


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