Second degree AV block causes: Difference between revisions

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Revision as of 17:07, 22 August 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2] Mahmoud Sakr, M.D. [3]
Synonyms and keywords:; AV block, atrioventricular block, heart block, Mobitz type I AV block, Mobitz type II AV block, Advanced second degree AV block, (Wenckebach) AV block

Overview

Atrioventricular (AV) block is defined as an interruption in the transmission of an impulse, either transient or permanent, from the atria to the ventricles due to an anatomic or functional impairment in the conduction system. In second degree AV block, some atrial impulses fail to reach the ventricles. Wenckebach described progressive delay between atrial and ventricular contraction and the eventual failure of an atrial beat to reach the ventricles. Mobitz subsequently divided second degree AV block into two subtypes, as determined by the findings on the electrocardiogram. In Mobitz type I AV block, progressive PR interval prolongation precedes a non-conducted P wave. While in Mobitz type II AV block, the PR interval remains unchanged prior to a P wave that suddenly fails to conduct to the ventricles.

Causes

Life Threatening Causes

Life-threatening conditions can result in death or permanent disability within 24 hours if left untreated.

Common Causes

Acute rheumatic fever
AV nodal disease
Bacterial endocarditis, especially of the aortic valve
β blockers may cause AV block
Calcific aortic stenosis
Degenerative disease
Digoxin
Dilated cardiomyopathy
Diltiazem
Enhanced vagal tone
HCM
Hypertension
Iatrogenic after correction of VSD, tetralogy of Fallot, and endocardial cushion defect
Inferior ST elevation MI
Massive calcification of the mitral annulus
myocarditis
Normal variants
Penetrating and non-penetrating trauma of the chest
Rheumatic Valvular Heart Disease
Sclerodegenerative disease of the bundle branches first described by Lenegre
Transposition of the great vessels
verapamil

Causes by Organ System

Cardiovascular	Acute myocardial infarction, acute rheumatic fever, ASD, dilated cardiomyopathy, Ebstein's anomaly, hypersensitive carotid sinus syndrome, hypertension, hypertrophic cardiomyopathy, idiopathic bilateral bundle branch fibrosis, idiopathic progressive cardiac conduction disease, 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, procainamide, propafenone, propoxyphene, quinidine, sotalol, terodiline
Ear Nose Throat	No underlying causes
Endocrine	Hyperthyroidism, myxedema, thyrotoxic periodic paralysis
Environmental	Hypothermia
Gastroenterologic	Hemochromatosis
Genetic	Emery-Dreifuss muscular dystrophy, Fabry disease, glycogenosis type 2b, hereditary neuromuscular neurodegenerative 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 syndrome, protozoal infection, sarcoidosis, SLE, tuberculosis
Musculoskeletal / Ortho	Ankylosing spondylitis, hereditary neuromuscular heredodegenerative 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 (for example in athletes), normal variants, pain, sleep , trauma

Causes in Alphabetical Order

Acute myocardial infarction (especially acute inferior MI)
Acute rheumatic fever
Amyloidosis
Ankylosing spondylitis
ASD
AV nodal disease
Beta-blockers
Calcium channel blockers
Cardiac glycosides
Chagas disease
Cholinesterase inhibitors
Dermatomyositis
Digitalis
Dilated cardiomyopathy
Diphtheria
Ebstein's anomaly
Endocardial cushion defect
Enhanced vagal tone (for example in athletes)
HCM
Hemochromatosis
Hypertension
Lyme disease
Muscular dystrophy
Myocarditis
Normal variants
Procainamide
Quinidine
Sarcoidosis
Scleroderma
SLE
Tetralogy of Fallot
Transposition of the great vessels
Valvular heart disease
VSD

References

Template:WikiDoc Sources

@@ Line 43: / Line 43: @@
 {|style="width:80%; height:100px" border="1"
 |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]]
+|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]], idiopathic bilateral bundle  branch fibrosis, idiopathic progressive  cardiac conduction disease, [[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"
@@ Line 55: / Line 55: @@
 |-bgcolor="LightSteelBlue"
 | '''Drug Side Effect'''
-|bgcolor="Beige"| [[Calcium channel blockers]], [[Beta-blockers]], [[Digitalis]], [[Cardiac glycosides]], [[Cholinesterase inhibitor]]s, [[Quinidine]],[[Procainamide]]
+|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]], [[procainamide]], [[propafenone]], [[propoxyphene]], [[quinidine]], [[sotalol]], [[terodiline]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 63: / Line 63: @@
 |-bgcolor="LightSteelBlue"
 | '''Endocrine'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Hyperthyroidism]], [[myxedema]], [[periodic  paralysis|thyrotoxic periodic paralysis]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Environmental'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Hypothermia]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 75: / Line 75: @@
 |-bgcolor="LightSteelBlue"
 | '''Genetic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Emery-Dreifuss muscular dystrophy]], [[Fabry disease]], [[glycogenosis type 2b]], hereditary neuromuscular neurodegenerative disease, [[Kearns-Sayre syndrome]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Hematologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Multiple myeloma]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''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"
 | '''Infectious Disease'''
-|bgcolor="Beige"| [[Acute rheumatic fever]], [[Chagas disease]], [[Diphtheria]], [[Lyme disease]], [[Myocarditis]]
+|bgcolor="Beige"| [[Acute rheumatic fever]], [[Chagas disease]], [[diphtheria]], [[Lyme disease]], [[myocarditis]], neonatal lupus syndrome, [[protozoa|protozoal infection]], [[sarcoidosis]], [[SLE]], [[tuberculosis]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Musculoskeletal / Ortho'''
-|bgcolor="Beige"| [[Ankylosing spondylitis]], [[Muscular dystrophy]]
+|bgcolor="Beige"| [[Ankylosing spondylitis]], hereditary neuromuscular heredodegenerative disease, [[Kearns-Sayre syndrome]], [[mitochondrial DNA|mitochondrial genome inherited conditions]],  [[muscular dystrophy]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 99: / Line 99: @@
 |-bgcolor="LightSteelBlue"
 | '''Nutritional / Metabolic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Fabry disease]], [[glycogenosis type 2b]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 107: / Line 107: @@
 |-bgcolor="LightSteelBlue"
 | '''Oncologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Multiple myeloma]]
 |-
 |-bgcolor="LightSteelBlue"
-| '''Ophthalmologic'''
+| '''Opthalmologic'''
 |bgcolor="Beige"| No underlying causes
 |-
@@ Line 127: / Line 127: @@
 |-bgcolor="LightSteelBlue"
 | '''Renal / Electrolyte'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Hyperkalemia]], [[hypokalemia]]
-|-
 |-bgcolor="LightSteelBlue"
 | '''Rheum / Immune / Allergy'''
-|bgcolor="Beige"| [[Ankylosing spondylitis]], [[Dermatomyositis]], [[Scleroderma]], [[SLE]]
+|bgcolor="Beige"| [[Ankylosing spondylitis]], [[dermatomyositis]], [[rheumatoid arthritis]], [[scleroderma]], [[SLE]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 151: / Line 151: @@
 |-bgcolor="LightSteelBlue"
 | '''Miscellaneous'''
-|bgcolor="Beige"|  [[Amyloidosis]], Enhanced vagal tone (for example in athletes), Normal variants
+|bgcolor="Beige"|  [[Amyloidosis]], [[degenerative diseases]], enhanced [[vagus nerve|vagal tone]] (for example in athletes), normal variants, [[pain]], [[sleep ]], [[trauma]]
 |-
 |}