Second degree AV block medical therapy: Difference between revisions
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{{CMG}}; {{AE}} [[User:Mohammed Salih|Mohammed Salih, M.D.]] {{CZ}} | {{CMG}}; {{AE}} [[User:Mohammed Salih|Mohammed Salih, M.D.]] {{CZ}} | ||
==Overview== | ==Overview== | ||
Treatment for a Mobitz type I (Wenckebach) is often not necessary. Occasionally type I blocks may result in bradycardia leading to hypotension. If hypotension and bradycardia occur, type I blocks respond well to atropine. If unresponsive to atropine, pacing (transcutaneous or transvenous) should be initiated for stabilization. | |||
If the patient is on any beta blockers, calcium channel blockers or digoxin, the dose of these medications should be reduced or the medication discontinued. All patients with Mobitz 1 block should be admitted and monitored. | |||
Treatment for a Mobitz type II involves initiating pacing as soon as this rhythm is identified. Type II blocks imply structural damage to the AV conduction system. This rhythm often deteriorates into complete heart block. These patients require transvenous pacing until a permanent pacemaker is placed. Unlike Mobitz type I (Wenckebach), patients that are bradycardic and hypotensive with a Mobitz type II rhythm often do not respond to atropine. | |||
==Medical Therapy== | ==Medical Therapy== | ||
Revision as of 17:05, 7 April 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammed Salih, M.D. Cafer Zorkun, M.D., Ph.D. [2]
Overview
Treatment for a Mobitz type I (Wenckebach) is often not necessary. Occasionally type I blocks may result in bradycardia leading to hypotension. If hypotension and bradycardia occur, type I blocks respond well to atropine. If unresponsive to atropine, pacing (transcutaneous or transvenous) should be initiated for stabilization.
If the patient is on any beta blockers, calcium channel blockers or digoxin, the dose of these medications should be reduced or the medication discontinued. All patients with Mobitz 1 block should be admitted and monitored.
Treatment for a Mobitz type II involves initiating pacing as soon as this rhythm is identified. Type II blocks imply structural damage to the AV conduction system. This rhythm often deteriorates into complete heart block. These patients require transvenous pacing until a permanent pacemaker is placed. Unlike Mobitz type I (Wenckebach), patients that are bradycardic and hypotensive with a Mobitz type II rhythm often do not respond to atropine.
Medical Therapy
Mobitz I
- Patients with type I Second degree AV block are usually asymptomatic and do not require a pacemaker.
- Correction of reversible causes of the block such as ischemia, medications, and vagotonic conditions should be addressed.
Mobitz II
- Correction of reversible causes of the block such as ischemia, medications, and vagotonic conditions should be considered.
- Treatment may also include medicines to control blood pressure and atrial fibrillation, as well as lifestyle and dietary changes to reduce risk factors associated with heart attack and stroke.
- Treatment in emergency situations are atropine and an external pacer.
Contraindicated medications
Second degree AV block(except in patients with a functioning artificial pacemaker) is considered an absolute contraindication to the use of the following medications:
- Adenosine
- Atenolol
- Betaxolol
- Bisoprolol
- Brimonidine tartrate and Timolol maleate
- Carteolol
- Diltiazem
- Disopyramide
- Dronedarone
- Flecainide
- Metoprolol
- Mexiletine
- Nadolol
- Nebivolol
- Penbutolol
- Pindolol
- Propranolol
- Sotalol
- Timolol
- Labetalol