Third degree AV block causes: Difference between revisions

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===Common Causes===
===Common Causes===
* Acute ST elevation MI - [[Complete heart block]] occurs in 2.5% to 8% of patients.<ref name="pmid18274563">{{cite journal |author=Malla RR, Sayami A |title=In hospital complications and mortality of patients of inferior wall myocardial infarction with right ventricular infarction |journal=JNMA J Nepal Med Assoc |volume=46 |issue=167 |pages=99–102 |year=2007 |pmid=18274563 |doi= |url=}}</ref>
*[[Acute rheumatic fever]]
** Inferior ST elevation [[MI]]: [[AV block]] is more common in patients with inferior [[MI]]s (1/3rd of patients).
*[[Coronary ischemia]]
*** In 90% of patients the inferior wall is supplied by the [[RCA]] which gives off a branch to the [[AV node]].
*[[Myocardial infarction]] <ref name="pmid18274563">{{cite journal |author=Malla RR, Sayami A |title=In hospital complications and mortality of patients of inferior wall myocardial infarction with right ventricular infarction |journal=JNMA J Nepal Med Assoc |volume=46 |issue=167 |pages=99–102 |year=2007 |pmid=18274563 |doi= |url=}}</ref>
*** As a rule the [[AV block]] is transient and normal function returns within a week of the acute episode.
*[[Systemic lupus erythematosus]]
** Anterior ST elevation [[MI]]: [[AV block]] may be seen in up to 21%.
*[[Valvular heart disease]]
*** Incidence of [[second degree AV block]] and [[third degree AV block]] is 5 to 7%.
*** Block is the result of damage to the interventricular septum supplied by the [[LAD]].
*** There is damage to the bundle branches either in the form of bilateral bundle branch block or [[trifascicular block]].
*** [[RBBB]], [[RBBB]] + [[LAHB]], [[RBBB]] + [[LPHB]] or [[LBBB]] often appear before the development of [[AV block]].
*** The PR is normal or minimally prolonged before the onset of [[second degree AV block]] or [[third degree AV block]].
*** Although the [[AV block]] is usually transient, there is a relatively high incidence of recurrence or high-degree AV block after the acute event.
*** In addition to [[ischemia]], [[fibrosis]] and [[calcification]] of the summit of the ventricular septum that involve the branching part of the bundle branches, may play a role in the genesis of the conduction defect.
*** It used to be thought that CAD was the most frequent cause of chronic [[complete AV block]], but it actually causes only 15% of cases.
 
* Degenerative diseases
** Sclerodegenerative disease of the bundle branches was first described by Lenegre.
** The pathologic process is called idiopathic bilateral bundle branch fibrosis and the heart block is called primary heart block.
** This is the most common cause of chronic [[AV block]] (46%).
** Lev described similar degenerative lesions, which he referred to as sclerosis of the left side of the cardiac skeleton. There is progressive [[fibrosis]] and calcification of the mitral annulus, the central fibrous body, the pars membranacea, the base of the [[aorta]], and the summit of the muscular ventricular septum. Various portions of the [[His bundle]] or the bundle branches may be involved, resulting in [[AV block]].
 
* Hypertension
** Chronic [[AV block]] in patients with [[HTN]] is thought to be due to [[CAD]] or sclerosis of the left side of the cardiac skeleton exacerbated by [[hypertension]].
 
* Diseases of the myocardium
** [[Acute rheumatic fever]]: PR prolongation is a common (25 to 95% of cases) sign in patients with [[acute rheumatic fever]]
*** Usually transient, disappears when the patient recovers
** [[Dilated cardiomyopathy]] results in various degrees of heart block are seen in 15% of patients
** [[HCM]]: 3% of patients with [[HCM]] will develop heart block
 
* Valvular heart disease
** Calcific [[aortic stenosis]] may be accompanied by chronic partial or complete AV block
** There is an extension of the calcification to involve the main bundle or its bifurcation, resulting in degeneration and necrosis of the conduction tissue
** May also occur in rheumatic mitral valve disease, but is less common
** Occasionally, massive calcification of the mitral annulus as an aging process may cause [[AV block]]
** May also be seen in [[bacterial endocarditis]], especially of the [[aortic valve]]
 
* Drugs
** [[Digoxin]] is one of the most common causes of reversible [[AV block]]
*** The ventricular response rate is more rapid than that due to organic lesions, and increased automaticity of the AV junctional pacemaker may be responsible.
** [[Quinidine]] and [[Procainamide]] may produce slight prolongation of the PR
** [[Beta blocker|β blockers]] may cause [[AV block]]
** [[Diltiazem]] and [[verapamil]] may cause AV conduction delay and [[PR interval]] prolongation
 
* Congenital
** Occurs in the absence of other evidence of organic heart disease
** Site is usually proximal to the bifurcation of the [[His bundle]], most often in the [[AV node]]
** Narrow [[QRS]] with a rate > 40 beats per minute
** Frequently seen in those with corrected [[transposition of the great vessels]], and occasionally in [[ASD]]s and [[Ebstein's anomaly]]<ref name="pmid20381087">{{cite journal |author=Lin A, Mahle WT, Frias PA, ''et al.'' |title=Early and delayed atrioventricular conduction block after routine surgery for congenital heart disease |journal=J. Thorac. Cardiovasc. Surg. |volume=140 |issue=1 |pages=158–60 |year=2010 |month=July |pmid=20381087 |doi=10.1016/j.jtcvs.2009.12.050 |url=}}</ref>
 
* Trauma
** May be induced during open heart surgery in the area of AV conduction tissue<ref name="pmid20723650">{{cite journal |author=Godin M, Eltchaninoff H, Furuta A, ''et al.'' |title=Frequency of conduction disturbances after transcatheter implantation of an Edwards Sapien aortic valve prosthesis |journal=Am. J. Cardiol. |volume=106 |issue=5 |pages=707–12 |year=2010 |month=September |pmid=20723650 |doi=10.1016/j.amjcard.2010.04.029 |url=}}</ref>
** Seen in patients operated on for the correction of [[ASD]]<ref name="pmid23285170">{{cite journal |author=Chen Q, Cao H, Zhang GC, ''et al.'' |title=Atrioventricular block subsequent to intraoperative device closure atrial septal defect with transthoracic minimal invasion; a rare and serious complication |journal=PLoS ONE |volume=7 |issue=12 |pages=e52726 |year=2012 |pmid=23285170 |pmc=3532427 |doi=10.1371/journal.pone.0052726 |url=}}</ref>, [[VSD]]<ref name="pmid18727001">{{cite journal |author=Zhou T, Shen XQ, Zhou SH, ''et al.'' |title=Atrioventricular block: a serious complication in and after transcatheter closure of perimembranous ventricular septal defects |journal=Clin Cardiol |volume=31 |issue=8 |pages=368–71 |year=2008 |month=August |pmid=18727001 |doi=10.1002/clc.20243 |url=}}</ref>, [[tetralogy of Fallot]], and [[endocardial cushion defect]].
** May be due to [[edema]], transient ischemia, or actual disruption of the conduction tissue. The block may therefore be permanent or transient.
** Also reported with both penetrating and non-penetrating trauma of the chest


===Causes by Organ System===
===Causes by Organ System===

Revision as of 19:10, 21 August 2013

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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

Many conditions can cause third degree heart block, but the most common cause is coronary ischemia. Progressive degeneration of the electrical conduction system of the heart can lead to third degree heart block. In addition, acute myocardial infarction may present with third degree AV block.
Third degree heart block may also be congenital and has been linked to the presence of lupus in the mother. The cause of congenital third degree heart block in many patients is unknown.

Causes

Life Threatening Causes

Third degree heart block is a life-threatening condition and must be treated as such irrespective of the causes. Life-threatening conditions can result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Causes by Organ System

Cardiovascular No underlying causes
Chemical/Poisoning No underlying causes
Dental No underlying causes
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Infectious Disease No underlying causes
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Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
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Psychiatric No underlying causes
Pulmonary No underlying causes
Renal/Electrolyte No underlying causes
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

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Causes in Alphabetical Order

References

  1. ↑ 1.0 1.1 Malla RR, Sayami A (2007). "In hospital complications and mortality of patients of inferior wall myocardial infarction with right ventricular infarction". JNMA J Nepal Med Assoc. 46 (167): 99–102. PMID 18274563.
  2. ↑ van Cleef AN, Schuurman MJ, Busari JO (2011). "Third-degree atrioventricular block in an adolescent following acute alcohol intoxication". BMJ Case Rep. 2011. doi:10.1136/bcr.07.2011.4547. PMID 22679160.
  3. ↑ Brvar M, Bunc M (2009). "High-degree atrioventricular block in acute ethanol poisoning: a case report". Cases J. 2: 8559. doi:10.4076/1757-1626-2-8559. PMC 2769457. PMID 19918387.
  4. ↑ Wills BK, Liu JM, Wahl M (2010). "Third-degree AV block from extended-release diltiazem ingestion in a nine-month-old". J Emerg Med. 38 (3): 328–31. doi:10.1016/j.jemermed.2007.10.053. PMID 18403171. Unknown parameter |month= ignored (help)
  5. ↑ Tian Z, Fang Q, Zhao DC; et al. (2010). "[The clinico-pathological manifestation of cardiac involvement in eosinophilic diseases]". Zhonghua Nei Ke Za Zhi (in Chinese). 49 (8): 684–7. PMID 20979789. Unknown parameter |month= ignored (help)
  6. ↑ 6.0 6.1 "Congenital complete atrioventricular block". Retrieved 21 August 2013.
  7. ↑ Lionakis N, Moyssakis I, Gialafos E, Dalianis N, Votteas V (2008). "Aortic dissection and third-degree atrioventricular block in a patient with a hypertensive crisis". J Clin Hypertens (Greenwich). 10 (1): 69–72. PMID 18174773. Unknown parameter |month= ignored (help)
  8. ↑ Amasyalı B, Barçın C, Kılıç A (2011). "[Supra-His complete atrioventricular block in a patient with subclinical hyperthyroidism]". Turk Kardiyol Dern Ars (in Turkish). 39 (8): 693–6. PMID 22257810. Unknown parameter |month= ignored (help)
  9. ↑ Liu R, Qiao SB, Hu FH, Yang WX, Yuan JS (2012). "[Clinical features of five patients with delayed third degree atrioventricular block after ethanol septal ablation for hypertrophic obstructive cardiomyopathy]". Zhonghua Xin Xue Guan Bing Za Zhi (in Chinese). 40 (12): 1009–11. PMID 23363714. Unknown parameter |month= ignored (help)
  10. ↑ Sykes JA, Lubega J, Ezetendu C, Verma R, O'Connor B, Kalyanaraman M (2011). "Asymptomatic complete atrioventricular block in a 13-year-old girl". Pediatr Emerg Care. 27 (11): 1081–3. doi:10.1097/PEC.0b013e3182360674. PMID 22068075. Unknown parameter |month= ignored (help)
  11. ↑ Bhattacharya IS, Dweck M, Francis M (2010). "Lyme carditis: a reversible cause of complete atrioventricular block". J R Coll Physicians Edinb. 40 (2): 121–2. doi:10.4997/JRCPE.2010.207. PMID 21125053. Unknown parameter |month= ignored (help)
  12. ↑ Wagner V, Zima E, Gellér L, Merkely B (2010). "[Acute atrioventricular block in chronic Lyme disease]". Orv Hetil (in Hungarian). 151 (39): 1585–90. doi:10.1556/OH.2010.28965. PMID 20840915. Unknown parameter |month= ignored (help)
  13. ↑ Semmler D, Blank R, Rupprecht H (2010). "Complete AV block in Lyme carditis: an important differential diagnosis". Clin Res Cardiol. 99 (8): 519–26. doi:10.1007/s00392-010-0152-8. PMID 20464556. Unknown parameter |month= ignored (help)
  14. ↑ Facenda-Lorenzo M, Hernández-Afonso J, Rodríguez-Esteban M, de León-Hernández JC, Grillo-Pérez JJ (2012). "Cardiac Manifestations in Myotonic Dystrophy Type 1 Patients Followed Using a Standard Protocol in a Specialized Unit". Rev Esp Cardiol. doi:10.1016/j.recesp.2012.08.011. PMID 23194837. Unknown parameter |month= ignored (help)
  15. ↑ Femenía F, Arce M, Arrieta M (2010). "[Systemic sclerosis complicated with syncope and complete AV block]". Medicina (B Aires) (in Spanish; Castilian). 70 (5): 442–4. PMID 20920962.
  16. ↑ Maleki AR, Nikyar B, Hosseini SM (2012). "Third-Degree Heart Block in Thalassemia major: A Case Report". Iran J Pediatr. 22 (2): 260–4. PMC 3446065. PMID 23056897. Unknown parameter |month= ignored (help)
  17. ↑ Thakar S, Chandra P, Pednekar M, Kabalkin C, Shani J (2012). "Complete heart block following a blow on the chest by a soccer ball: a rare manifestation of commotio cordis". Ann Noninvasive Electrocardiol. 17 (3): 280–2. doi:10.1111/j.1542-474X.2012.00518.x. PMID 22816548. Unknown parameter |month= ignored (help)
  18. ↑ Portet N, Riu B, Bounes V, Minville V, Fourcade O (2012). "Left ventricular-right atrial communication with third-degree atrioventricular block after thoracic trauma". J Emerg Med. 43 (6): e385–8. doi:10.1016/j.jemermed.2010.11.059. PMID 21621364. Unknown parameter |month= ignored (help)
  19. ↑ Frikha Z, Abid L, Abid D; et al. (2011). "Cardiac tamponade and paroxysmal third-degree atrioventricular block revealing a primary cardiac non-Hodgkin large B-cell lymphoma of the right ventricle: a case report". J Med Case Rep. 5: 433. doi:10.1186/1752-1947-5-433. PMC 3180417. PMID 21892927.
  20. ↑ Houchaymi Z, Helou S, Ballout J (2010). "[Pericardial tamponade and third-degree atrioventricular block revealing a primary cardiac lymphoma]". Rev Med Interne (in French). 31 (11): e4–6. doi:10.1016/j.revmed.2010.01.014. PMID 20605278. Unknown parameter |month= ignored (help)


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