Second degree AV block history and symptoms: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Second degree AV block}} | {{Second degree AV block}} | ||
{{CMG}}; {{AE}} {{CZ}} | {{CMG}}; {{AE}} {{Sara.Zand}} {{CZ}} | ||
== Overview== | |||
Common [[symptoms]] in [[patients]] with second degree [[atrioventricular block]] include [[light-headedness]], [[dizziness]], [[fainting]], [[fatigue]], [[heart failure]] symptoms | |||
, [[pre-syncope]], and [[syncope]]. Mobitz type 1 second degree [[AV block]] (Wenckebach) is often asymptomatic and can be seen in [[active]], [[healthy ]] [[patients]] without known [[heart]] [[disease]]. It may occur during [[exercise ]] causing [[exertional intolerance]] or [[dizziness]], or [[syncope]]. In [[patients]] with intermittent [[atrioventricular block]] leading [[syncope]], initial evaluation including [[resting]] [[ECG]], [[physical exam]], [[echocardiography]] may be normal and intermittent episodes of the [[atrioventricular block]] can be found with long-term [[monitoring]]. [[Symptoms]] in [[patients]] with an [[atrioventricular block]] that conducts in a 2:1 pattern include [[fatigue]] and [[dizziness]] particularly if it persists during [[exertion]]. | |||
==History== | |||
* History from patients with second degree AV block should involve asking about the following:<ref name="pmid7405798">{{cite journal |vauthors=Zeppilli P, Fenici R, Sassara M, Pirrami MM, Caselli G |title=Wenckebach second-degree A-V block in top-ranking athletes: an old problem revisited |journal=Am. Heart J. |volume=100 |issue=3 |pages=281–94 |date=September 1980 |pmid=7405798 |doi=10.1016/0002-8703(80)90140-4 |url=}}</ref><ref name="pmid29083636">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=29083636 | doi= | pmc= | url= }}</ref> | |||
** [[Congenital heart disease]] | |||
** Current [[heart]] [[condition]] | |||
** Recent or previous [[cardiac]] [[procedures]] | |||
**[[ History]] of [[medications]] | |||
==Symptoms== | ==Symptoms== | ||
*Common [[symptoms]] in [[patients]] with second degree [[atrioventricular block]] include:<ref name="pmid6373268">{{cite journal |vauthors=Bexton RS, Camm AJ |title=Second degree atrioventricular block |journal=Eur. Heart J. |volume=5 Suppl A |issue= |pages=111–4 |date=March 1984 |pmid=6373268 |doi=10.1093/eurheartj/5.suppl_a.111 |url=}}</ref><ref name="pmid8445186">{{cite journal |vauthors=Wogan JM, Lowenstein SR, Gordon GS |title=Second-degree atrioventricular block: Mobitz type II |journal=J Emerg Med |volume=11 |issue=1 |pages=47–54 |date=1993 |pmid=8445186 |doi=10.1016/0736-4679(93)90009-v |url=}}</ref> | |||
*[[Light-headedness]] | **[[Light-headedness]] | ||
*[[Dizziness]] | **[[Dizziness]] | ||
*[[Fainting]] | **[[Fainting]] | ||
*[[Fatigue]] | **[[Fatigue]] | ||
*[[Heart failure]] symptoms | **[[Heart failure]] symptoms | ||
*[[Pre-syncope]] | **[[Pre-syncope]] | ||
*[[Syncope]] | **[[Syncope]] | ||
* Mobitz type 1 second degree [[AV block]] (Wenckebach) is often asymptomatic and can be seen in [[active]], [[healthy ]] [[patients]] without known [[heart]] [[disease]].<ref name="pmid11988196">{{cite journal| author=Meimoun P, Zeghdi R, D'Attelis N, Berrebi A, Braunberger E, Deloche A | display-authors=etal| title=Frequency, predictors, and consequences of atrioventricular block after mitral valve repair. | journal=Am J Cardiol | year= 2002 | volume= 89 | issue= 9 | pages= 1062-6 | pmid=11988196 | doi=10.1016/s0002-9149(02)02276-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11988196 }} </ref><ref name="pmid29493981">{{cite journal |vauthors=Mangi MA, Jones WM, Napier L |title= |journal= |volume= |issue= |pages= |date= |pmid=29493981 |doi= |url=}}</ref> | |||
* Mobitz type 1 second degree [[AV block]] (Wenckebach) may occur during [[exercise ]] causing [[exertional intolerance]] or [[dizziness]], or [[syncope]]. | |||
* In [[patients]] with intermittent [[atrioventricular block]] leading [[syncope]], initial evaluation including [[resting]] [[ECG]], [[physical exam]], [[echocardiography]] may be normal. | |||
*Intermittent episodes of the [[atrioventricular block]] may be paroxysmal and found with long-term [[monitoring]].<ref name="pmid21570228">{{cite journal |vauthors=Brignole M, Deharo JC, De Roy L, Menozzi C, Blommaert D, Dabiri L, Ruf J, Guieu R |title=Syncope due to idiopathic paroxysmal atrioventricular block: long-term follow-up of a distinct form of atrioventricular block |journal=J Am Coll Cardiol |volume=58 |issue=2 |pages=167–73 |date=July 2011 |pmid=21570228 |doi=10.1016/j.jacc.2010.12.045 |url=}}</ref> | |||
* It was identified that in [[patients]] with [[syncope]] and evidence of [[bundle branch block]] or [[bifascicular block]] in resting [[ECG]], there was 61% His Purkinje conduction abnormalities in [[electrophysiologic study]].<ref name="pmid19578058">{{cite journal |vauthors=Marti-Almor J, Cladellas M, Bazan V, Altaba C, Guijo M, Delclos J, Bruguera-Cortada J |title=Long-term mortality predictors in patients with chronic bifascicular block |journal=Europace |volume=11 |issue=9 |pages=1201–7 |date=September 2009 |pmid=19578058 |doi=10.1093/europace/eup181 |url=}}</ref> | |||
* [[Symptoms]] in [[patients]] with an [[atrioventricular block]] that conducts in a 2:1 pattern include [[fatigue]] and [[dizziness]] particularly if it persists during [[exertion]]. | |||
* If the [[sinus rate]] is slow and only a few [[beats]] are conducted, there may be a significantly [[reduced cardiac output]]. | |||
==References== | ==References== | ||
Latest revision as of 06:45, 8 July 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3]
Overview
Common symptoms in patients with second degree atrioventricular block include light-headedness, dizziness, fainting, fatigue, heart failure symptoms , pre-syncope, and syncope. Mobitz type 1 second degree AV block (Wenckebach) is often asymptomatic and can be seen in active, healthy patients without known heart disease. It may occur during exercise causing exertional intolerance or dizziness, or syncope. In patients with intermittent atrioventricular block leading syncope, initial evaluation including resting ECG, physical exam, echocardiography may be normal and intermittent episodes of the atrioventricular block can be found with long-term monitoring. Symptoms in patients with an atrioventricular block that conducts in a 2:1 pattern include fatigue and dizziness particularly if it persists during exertion.
History
- History from patients with second degree AV block should involve asking about the following:[1][2]
- Congenital heart disease
- Current heart condition
- Recent or previous cardiac procedures
- History of medications
Symptoms
- Common symptoms in patients with second degree atrioventricular block include:[3][4]
- Mobitz type 1 second degree AV block (Wenckebach) is often asymptomatic and can be seen in active, healthy patients without known heart disease.[5][6]
- Mobitz type 1 second degree AV block (Wenckebach) may occur during exercise causing exertional intolerance or dizziness, or syncope.
- In patients with intermittent atrioventricular block leading syncope, initial evaluation including resting ECG, physical exam, echocardiography may be normal.
- Intermittent episodes of the atrioventricular block may be paroxysmal and found with long-term monitoring.[7]
- It was identified that in patients with syncope and evidence of bundle branch block or bifascicular block in resting ECG, there was 61% His Purkinje conduction abnormalities in electrophysiologic study.[8]
- Symptoms in patients with an atrioventricular block that conducts in a 2:1 pattern include fatigue and dizziness particularly if it persists during exertion.
- If the sinus rate is slow and only a few beats are conducted, there may be a significantly reduced cardiac output.
References
- ↑ Zeppilli P, Fenici R, Sassara M, Pirrami MM, Caselli G (September 1980). "Wenckebach second-degree A-V block in top-ranking athletes: an old problem revisited". Am. Heart J. 100 (3): 281–94. doi:10.1016/0002-8703(80)90140-4. PMID 7405798.
- ↑ "StatPearls". 2020. PMID 29083636.
- ↑ Bexton RS, Camm AJ (March 1984). "Second degree atrioventricular block". Eur. Heart J. 5 Suppl A: 111–4. doi:10.1093/eurheartj/5.suppl_a.111. PMID 6373268.
- ↑ Wogan JM, Lowenstein SR, Gordon GS (1993). "Second-degree atrioventricular block: Mobitz type II". J Emerg Med. 11 (1): 47–54. doi:10.1016/0736-4679(93)90009-v. PMID 8445186.
- ↑ Meimoun P, Zeghdi R, D'Attelis N, Berrebi A, Braunberger E, Deloche A; et al. (2002). "Frequency, predictors, and consequences of atrioventricular block after mitral valve repair". Am J Cardiol. 89 (9): 1062–6. doi:10.1016/s0002-9149(02)02276-2. PMID 11988196.
- ↑ Mangi MA, Jones WM, Napier L. PMID 29493981. Missing or empty
|title=(help) - ↑ Brignole M, Deharo JC, De Roy L, Menozzi C, Blommaert D, Dabiri L, Ruf J, Guieu R (July 2011). "Syncope due to idiopathic paroxysmal atrioventricular block: long-term follow-up of a distinct form of atrioventricular block". J Am Coll Cardiol. 58 (2): 167–73. doi:10.1016/j.jacc.2010.12.045. PMID 21570228.
- ↑ Marti-Almor J, Cladellas M, Bazan V, Altaba C, Guijo M, Delclos J, Bruguera-Cortada J (September 2009). "Long-term mortality predictors in patients with chronic bifascicular block". Europace. 11 (9): 1201–7. doi:10.1093/europace/eup181. PMID 19578058.