Second degree AV block causes

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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] 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.

• Acute myocardial infarction
• Acute rheumatic fever
• Bacterial endocarditis
• Myocarditis
• Severe hypothermia

Common Causes

• Acute rheumatic fever
• AV nodal disease
• Bacterial endocarditis, especially of the aortic valve
• β blockers
• 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
• Sclerodegenerative disease of the electrical conduction system
• 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

• Acute rheumatic fever

• Amyloidosis

• Ankylosing spondylitis

• ASD

• Bacterial endocarditis

• Beta-blockers

• Calcific aortic stenosis

• Calcium channel blockers

• Cardiac glycosides

• Cardiac tumors

• Chagas disease

• Cholinesterase inhibitors

• Clonidine

• Degenerative diseases

• Dermatomyositis

• Digitalis

• Digoxin

• Dilated cardiomyopathy

• Diltiazem

• Diphtheria

• Disopyramide

• Dolasetron

• Donepezil

• Drugs

• Ebstein anomaly

• Ebstein's anomaly

• Electrolyte disturbances

• Emery-Dreifuss muscular dystrophy, x-linked

• Endocarditis

• Enhanced vagal tone in athletes

• Eslicarbazepine acetate

• Fabry disease

• Fesoterodine

• Fingolimod

• Glycogenosis type 2b

• HCM

• Hereditary neuromuscular neurodegenerative disease

• Hodgkin lymphoma

• Hyperkalaemia

• Hypersensitive carotid sinus syndrome

• Hyperthyroidism

• Hypokalaemia

• Hypothermia

• Ibutilide

• Idiopathic bilateral bundle branch fibrosis

• Idiopathic progressive cardiac conduction disease

• Ischaemic heart disease

• Kearns-Sayre syndrome

• Labetalol

• Lacosamide

• Lanatoside C

• Lenegre's disease

• Lev's disease

• Lyme disease

• Mitochondrial genome inherited conditions

• Multiple myeloma

• Muscular dystrophy

• Myocardial bridging

• Myocarditis

• Myotonic dystrophy

• Myxedema

• Neonatal lupus syndrome

• Normal variants of PR prolongation

• Paget disease

• Pain

• Paliperidone

• Post aortic valve replacement

• Post catheter ablation for arrhythmias

• Post closure of a ventricular septal defect

• Post mitral valve replacement

• Procainamide

• Propoxyphene

• Propranolol

• Protozoal infection

• Quinidine

• Quinine

• Rheumatic mitral valve disease

• Sarcoidosis

• SLE

• Sleep

• Systemic sclerosis

• Terodiline

• Tetralogy of fallot

• Thyrotoxic periodic paralysis

• Tolterodine

• Transposition of the great vessels

• Trauma

• Vagal maneuvers

• Valsalva manouevre

• Valvular heart disease

• Verapamil

• VSD

• X-linked inherited conditions

References

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