First degree AV block causes: Difference between revisions

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{{First degree AV block}}
{{First degree AV block}}
{{CMG}}; {{AE}} {{CZ}}; {{RT}}
{{CMG}}; {{AE}} {{CZ}}; {{RT}}
<br>{{SK}}; [[AV block]], [[atrioventricular block]], [[heart block]]


==Overview==
==Overview==
 
Common causes of [[first-degree AV block]] include [[ischemic heart disease]], [[congenital heart disease]], [[electrolyte]] abnormalities (particularly [[hypokalemia]] and [[hypomagnesemia]]), [[inflammation]], [[infections]] ([[endocarditis]], [[rheumatic fever]], [[Chagas disease]], [[Lyme disease]], [[diphtheria]]), [[drugs]] ([[antiarrhythmic ]] Ia, Ic, II, III, IV and [[digoxin]], [[β-blockers]], [[calcium channel blockers]] ), [[infiltrative diseases]] ([[sarcoidosis]]), [[collagen vascular diseases]] ([[SLE]], [[rheumatoid arthritis]], [[scleroderma]]), idiopathic degenerative diseases ([[Lenegre]] and [[Lev diseases]]) and [[neuromuscular disorders]]  and increased [[vagal tone]] in younger [[patients]].
An atrioventricular block (or AV block) is a type of [[heart block]] involving an impairment of the conduction between the [[atria]] and [[ventricles]] of the heart.<ref>{{Dorlands|b_16|12188991}}</ref>  It usually involves the [[atrioventricular node]], but it can involve other structures too. AV block is categorized by degree and site of conduction block. In first-degree AV block, all atrial impulses are conducted to the ventricle. However, there is a delay within the [[AV node]], resulting in a [[prolonged PR interval]] on [[ECG]] (>200 msec or >5 small blocks). In other words, first degree block is a slowed conduction without loss of atrioventricular synchrony.


==Causes==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening conditions can result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
* [[Acute myocardial infarction]]
*[[Acute myocardial infarction]]
* [[Acute rheumatic fever]]
*[[Acute rheumatic fever]]
* [[Bacterial endocarditis]]
*[[Bacterial endocarditis]]
* [[Myocarditis]]
*[[Myocarditis]]


===Common Causes===
===Common Causes===
* [[Hyperkalemia]]
*[[Hyperkalemia]]
* [[Hyperthyroidism]]
*[[Hyperthyroidism]]
* [[Increased vagal tone]] (e.g. sleep, athletes)
*[[Hypothyroidism]]
* Ischemic heart disease
*[[vagus nerve|Increased vagal tone]] (e.g. [[sleep]], athletes)
* Medications ( e.g. [[adenosine]], [[amiodarone]], [[beta-blockers]], [[diltiazem]], [[procainamide]], [[verapamil]]
*[[Ischemic heart disease]]
*Medications ( e.g. [[adenosine]], [[amiodarone]], [[beta-blockers]], [[diltiazem]], [[procainamide]], [[verapamil]])


===Causes by Organ System===
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | AV nodal disease, [[Myocarditis]], Acute [[myocardial infarction]] (especially acute inferior MI), [[Hypertension]], [[Acute rheumatic fever]], [[Dilated cardiomyopathy]], [[HCM]], [[Myocarditis]], [[Valvular heart disease]], [[Transposition of the great vessels]], [[ASD]]s, [[Ebstein's anomaly]], [[VSD]], [[Tetralogy of Fallot]], [[Endocardial cushion defect]], [[Lev's disease]]
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Acute myocardial infarction]], [[acute rheumatic fever]], [[ASD]], [[dilated cardiomyopathy]], [[Ebstein's anomaly]], [[Carotid sinus hypersensitivity|hypersensitive carotid sinus syndrome]], [[hypertension]], [[hypertrophic cardiomyopathy]], [[Lev's disease]], [[myocardial bridging]], [[myocarditis]], [[Aortic valve  replacement|post aortic valve  replacement]], [[catheter ablation|post catheter ablation for arrhythmias]], [[ventricular septal defect surgery|post closure of a ventricular septal defect]], [[mitral valve replacement|post mitral valve replacement]], [[tetralogy of Fallot]], [[endocardial cushion defect]], [[transposition of the great vessels]],  [[valvular heart disease]], [[VSD]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Calcium channel blockers]], [[Beta-blockers]], [[Digitalis]], [[Cardiac glycosides]], [[Cholinesterase inhibitor]]s, [[Quinidine]], [[Procainamide]], [[Disopyramide]], [[Flecainide]], [[Encainide]], [[Propafenone]], [[Amiodarone]], [[Sotalol]], [[Dofetilide]], [[Ibutilide]], [[Magnesium]]
|bgcolor="Beige"| [[Amiodarone]], [[beta-blockers]], [[digitalis]], [[calcium channel blockers]], [[cholinesterase inhibitor|cholinesterase inhibitors]], [[disopyramide]], [[dofetilide]], [[dolasetron]], [[donepezil]], [[eslicarbazepine acetate]], [[fesoterodine]], [[fingolimod]], [[flecainide]], [[ibutilide]], [[lacosamide]], [[magnesium]], [[paliperidone]], [[pramipexole]], [[procainamide]], [[propafenone]], [[propoxyphene]], [[quinidine]], [[sotalol]], [[terodiline]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Hyperthyroidism]], [[myxedema]], [[periodic  paralysis|thyrotoxic periodic paralysis]], [[hypothyroidism]]
|-  
|-  
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Hypothermia]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Emery-Dreifuss muscular dystrophy]], [[Fabry disease]], [[glycogenosis type 2b]], [[Neuromuscular disease|hereditary neuromuscular disease]], [[Kearns-Sayre syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Multiple myeloma]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[aortic valve  replacement|Post aortic valve  replacement]], [[catheter ablation|post catheter ablation for  arrhythmias]], [[ventricular septal defect surgery|post closure of a  ventricular septal defect]], [[mitral valve  replacement|post mitral valve  replacement]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| [[Acute rheumatic fever]], [[Chagas disease]], [[Diphtheria]], [[Lyme disease]], [[Myocarditis]], [[Tuberculosis]]
|bgcolor="Beige"| [[Acute rheumatic fever]], [[Chagas disease]], [[diphtheria]], [[Lyme disease]], [[myocarditis]], [[neonatal lupus erythematosus]], [[protozoa|protozoal infection]], [[sarcoidosis]], [[SLE]], [[tuberculosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Ankylosing spondylitis]], [[Muscular dystrophy]]
|bgcolor="Beige"| [[Ankylosing spondylitis]], [[Neuromuscular disease|hereditary neuromuscular disease]], [[Kearns-Sayre syndrome]], [[mitochondrial disease|mitochondrial genome inherited conditions]],  [[muscular dystrophy]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Fabry disease]], [[glycogenosis type 2b]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Multiple myeloma]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Hyperkalemia]], [[hypokalemia]]
|-
 
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Ankylosing spondylitis]], [[Dermatomyositis]], [[Scleroderma]], [[SLE]], [[Rheumatoid arthritis]]
|bgcolor="Beige"| [[Ankylosing spondylitis]], [[dermatomyositis]], [[rheumatoid arthritis]], [[scleroderma]], [[SLE]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"|  [[Amyloidosis]], Enhanced vagal tone (for example in athletes), Normal variants
|bgcolor="Beige"|  [[Amyloidosis]], [[degenerative diseases]],  [[vagus nerve|enhanced  vagal tone]], [[PR interval|normal variants]]
|-
|-
|}
|}
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{{col-begin|width=80%}}
{{col-begin|width=80%}}
{{col-break|width=33%}}
{{col-break|width=33%}}
* [[Acute myocardial infarction]]
*[[Acute myocardial infarction]]
 
*[[Acute rheumatic fever]]
* [[Acute rheumatic fever]]
*[[Amyloidosis]]
 
*[[Ankylosing spondylitis]]
* [[Amyloidosis]]
*[[ASD]]
 
*[[Bacterial endocarditis]]
* [[Ankylosing spondylitis]]
*[[Beta-blockers]]
 
*[[Calcific aortic stenosis]]
* [[ASD]]
*[[Calcium channel blockers]]
 
*[[Cardiac glycosides]]
* [[Bacterial endocarditis]]
*[[Cardiac tumors]]
 
*[[Chagas disease]]
* [[Beta-blockers]]
*[[Cholinesterase inhibitors]]
 
*[[Clonidine]]
* [[Calcific aortic stenosis]]
*[[Degenerative diseases]]
 
*[[Dermatomyositis]]
* [[Calcium channel blockers]]
*[[Digitalis]]
 
*[[Digoxin]]
* [[Cardiac glycosides]]
*[[Dilated cardiomyopathy]]
 
*[[Diltiazem]]
* [[Cardiac tumors]]
*[[Diphtheria]]
 
*[[Disopyramide]]
* [[Chagas disease]]
*[[Dolasetron]]
 
*[[Donepezil]]
* [[Cholinesterase inhibitors]]
*[[Ebstein anomaly]]
 
*[[Ebstein's anomaly]]
* [[Clonidine]]
*[[Electrolyte disturbances]]
 
*[[Emery-Dreifuss muscular dystrophy]]
* [[Degenerative diseases]]
*[[vagus nerve|Enhanced vagal tone in athletes]]  
 
* [[Dermatomyositis]]
 
* [[Digitalis]]
 
* [[Digoxin]]
 
* [[Dilated cardiomyopathy]]
 
* [[Diltiazem]]
 
* [[Diphtheria]]
 
* [[Disopyramide]]
 
* [[Dolasetron]]
 
* [[Donepezil]]
 
* [[Drugs]]
 
* [[Ebstein anomaly]]
 
* [[Ebstein's anomaly]]
 
* [[Electrolyte disturbances]]
 
* [[Emery-Dreifuss muscular dystrophy]], [[x-linkage|x-linked]]
 
* [[Endocarditis]]
 
* Enhanced vagal tone in athletes
 
* [[Eslicarbazepine acetate]]
{{col-break|width=33%}}
{{col-break|width=33%}}
* [[Fabry disease]]
*[[Eslicarbazepine acetate]]
 
*[[Fabry disease]]
* [[Fesoterodine]]
*[[Fesoterodine]]
 
*[[Fingolimod]]
* [[Fingolimod]]
*[[Glycogenosis type 2b]]
 
*[[HCM]]
* [[Glycogenosis type 2b]]
* [[Neuromuscular disease|Hereditary neuromuscular disease]]
 
*[[Hodgkin lymphoma]]
* [[HCM]]
*[[Hyperkalaemia]]
 
*[[Carotid sinus hypersensitivity|Hypersensitive carotid sinus syndrome]]
* Hereditary neuromuscular heredodegenerative disease
*[[Hyperthyroidism]]
 
*[[Hypokalaemia]]
* [[Hodgkin lymphoma]]
*[[Hypothermia]]
 
*[[Ibutilide]]
* [[Hyperkalaemia]]
*[[Ischaemic heart disease]]
 
*[[Kearns-Sayre syndrome]]
* [[Carotid sinus hypersensitivity|Hypersensitive carotid sinus syndrome]]
*[[Labetalol]]
 
*[[Lacosamide]]
* [[Hyperthyroidism]]
*[[Lanatoside C]]
 
*[[Lenegre's disease]]
* [[Hypokalaemia]]
*[[Lev's disease]]
 
*[[Lyme disease]]
* [[Hypothermia]]
*[[Mitochondrial DNA|Mitochondrial genome inherited conditions]]
 
*[[Multiple myeloma]]
* [[Ibutilide]]
*[[Muscular dystrophy]]
 
*[[Myocardial bridging]]
* [[Idiopathic bilateral bundle  branch fibrosis]]
*[[Myocarditis]]
 
*[[Myotonic dystrophy]]
* [[Idiopathic progressive  cardiac conduction disease]]
*[[Myxedema]]
 
* [[Ischaemic heart disease]]
 
* [[Kearns-Sayre syndrome]]
 
* [[Labetalol]]
 
* [[Lacosamide]]
 
* [[Lanatoside C]]
 
* [[Lenegre's disease]]
 
* [[Lev's disease]]
 
* [[Lyme disease]]
 
* [[Mitochondrial DNA|Mitochondrial genome inherited conditions]]
 
* [[Multiple myeloma]]
 
* [[Muscular dystrophy]]
 
* [[Myocardial bridging]]
 
* [[Myocarditis]]
 
* [[Myotonic dystrophy]]
 
* [[Myxedema]]
 
* Neonatal lupus syndrome
 
* Normal variants of PR  prolongation
{{col-break|width=33%}}
{{col-break|width=33%}}
 
*[[Neonatal lupus erythematosus]]
* [[Paget disease]]
*[[prolonged PR interval|Normal variants of PR  prolongation]]
 
*[[Paliperidone]]
* [[Pain]]
*[[aortic valve  replacement|Post aortic valve replacement ]]
 
*[[catheter ablation|Post catheter ablation for  arrhythmias]]
* [[Paliperidone]]
*[[Ventricular septal defect surgery|Post closure of a  ventricular septal defect]]
 
*[[mitral valve  replacement|Post mitral valve  replacement]]
* Post [[aortic valve  replacement ]]
*[[Procainamide]]
 
*[[Propoxyphene]]
* [[catheter ablation|Post catheter ablation for  arrhythmias]]
*[[Propranolol]]
 
*[[Protozoa|Protozoal infection]]
* [[Ventricular septal defect surgery|Post closure of a  ventricular septal defect]]
*[[Quinidine]]
 
*[[Quinine]]
* [[mitral valve  replacement|Post mitral valve  replacement]]
*[[Rheumatic fever|Rheumatic mitral valve disease]]
 
*[[Sarcoidosis]]
* [[Procainamide ]]
*[[SLE]]
 
*[[Systemic sclerosis]]
* [[Propoxyphene]]
*[[Terodiline]]
 
*[[Tetralogy of Fallot]]
* [[Propranolol]]
*[[periodic  paralysis|Thyrotoxic periodic  paralysis]]
 
*[[Tolterodine]]
* [[Protozoa|Protozoal infection]]
*[[Transposition of the great  vessels]]
 
*[[vagus nerve|Vagal maneuvers]]
* [[Quinidine]]
*[[Valsalva maneuver]]
 
*[[Valvular heart disease]]
* [[Quinine]]
*[[Verapamil]]
 
*[[VSD]]
* Rheumatic mitral valve disease
*[[sex linkage|X-linked inherited  conditions]]
 
* [[Sarcoidosis]]
 
* [[SLE]]
 
* [[Sleep ]]
 
* [[Systemic sclerosis]]
 
* [[Terodiline]]
 
* [[Tetralogy of fallot]]
 
* [[periodic  paralysis|Thyrotoxic periodic  paralysis]]
 
 
* [[Tolterodine]]
 
* [[Transposition of the great  vessels]]
 
* [[Trauma]]
 
* [[Vagal maneuvers]]
 
* [[Valsalva manouevre]]
 
* [[Valvular heart disease]]
 
* [[Verapamil]]
 
* [[VSD]]
 
* [[sex linkage|X-linked inherited  conditions]]
{{col-end}}
{{col-end}}


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{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 04:51, 22 July 2021

First degree AV block Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Raviteja Guddeti, M.B.B.S. [3]

Overview

Common causes of first-degree AV block include ischemic heart disease, congenital heart disease, electrolyte abnormalities (particularly hypokalemia and hypomagnesemia), inflammation, infections (endocarditis, rheumatic fever, Chagas disease, Lyme disease, diphtheria), drugs (antiarrhythmic Ia, Ic, II, III, IV and digoxin, β-blockers, calcium channel blockers ), infiltrative diseases (sarcoidosis), collagen vascular diseases (SLE, rheumatoid arthritis, scleroderma), idiopathic degenerative diseases (Lenegre and Lev diseases) and neuromuscular disorders and increased vagal tone in younger patients.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Acute myocardial infarction, acute rheumatic fever, ASD, dilated cardiomyopathy, Ebstein's anomaly, hypersensitive carotid sinus syndrome, hypertension, hypertrophic cardiomyopathy, Lev's disease, myocardial bridging, myocarditis, post aortic valve replacement, post catheter ablation for arrhythmias, post closure of a ventricular septal defect, post mitral valve replacement, tetralogy of Fallot, endocardial cushion defect, transposition of the great vessels, valvular heart disease, VSD
Chemical / poisoning No underlying causes
Dermatologic No underlying causes
Drug Side Effect Amiodarone, beta-blockers, digitalis, calcium channel blockers, cholinesterase inhibitors, disopyramide, dofetilide, dolasetron, donepezil, eslicarbazepine acetate, fesoterodine, fingolimod, flecainide, ibutilide, lacosamide, magnesium, paliperidone, pramipexole, procainamide, propafenone, propoxyphene, quinidine, sotalol, terodiline
Ear Nose Throat No underlying causes
Endocrine Hyperthyroidism, myxedema, thyrotoxic periodic paralysis, hypothyroidism
Environmental Hypothermia
Gastroenterologic Hemochromatosis
Genetic Emery-Dreifuss muscular dystrophy, Fabry disease, glycogenosis type 2b, hereditary neuromuscular disease, Kearns-Sayre syndrome
Hematologic Multiple myeloma
Iatrogenic Post aortic valve replacement, post catheter ablation for arrhythmias, post closure of a ventricular septal defect, post mitral valve replacement
Infectious Disease Acute rheumatic fever, Chagas disease, diphtheria, Lyme disease, myocarditis, neonatal lupus erythematosus, protozoal infection, sarcoidosis, SLE, tuberculosis
Musculoskeletal / Ortho Ankylosing spondylitis, hereditary neuromuscular disease, Kearns-Sayre syndrome, mitochondrial genome inherited conditions, muscular dystrophy
Neurologic No underlying causes
Nutritional / Metabolic Fabry disease, glycogenosis type 2b
Obstetric/Gynecologic No underlying causes
Oncologic Multiple myeloma
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Sarcoidosis
Renal / Electrolyte Hyperkalemia, hypokalemia
Rheum / Immune / Allergy Ankylosing spondylitis, dermatomyositis, rheumatoid arthritis, scleroderma, SLE
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Amyloidosis, degenerative diseases, enhanced vagal tone, normal variants

Causes in Alphabetical Order

References


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