Full heart blockage
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Understanding Full Heart Block: Causes, Symptoms, and Treatment
Etiology of Complete Heart Block
Complete heart block, also known as third-degree atrioventricular (AV) block, occurs when the electrical signals from the atria do not reach the ventricles, leading to a disconnection between the upper and lower chambers of the heart. This condition can arise from various causes, including coronary artery disease, myocardial infarction, hypertensive heart disease, and digitalis intoxication . In elderly patients, coronary sclerosis is a common cause, often linked to the prevalence of coronary heart disease in later life. Additionally, fibrosis of the conduction system is frequently observed in older patients.
Clinical Features and Symptoms
Patients with complete heart block often present with a range of symptoms, including severe chest pain, breathlessness, excessive palpitation, vertigo, and sweating . Syncope, or fainting, is also a common symptom due to the irregular and often slow heart rate (bradycardia) associated with this condition. The severity of symptoms can vary, but the prognosis is generally poor, especially in symptomatic cases.
Diagnosis and Patient History
Diagnosis of complete heart block typically involves electrocardiographic studies, which reveal the disconnection between atrial and ventricular activity. In a clinical study, arteriosclerotic heart disease was identified as the chief etiologic factor in a significant number of cases. Patient history often includes episodes of syncope, atypical chest pain, and other symptoms indicative of bradyarrhythmias. For instance, a 71-year-old male patient presented with severe chest pain, breathlessness, and excessive palpitation, highlighting the critical nature of the condition.
Treatment and Prognosis
Treatment for complete heart block may involve the use of medications such as Isuprel (isopropyl norepinephrine) to manage symptoms, although the prognosis largely depends on the stability of the idioventricular pacemaker and the underlying cause of the block. In cases of acute myocardial infarction, atrioventricular block is often reversible, suggesting that permanent pacemaker installation should be postponed until the condition stabilizes. However, in many cases, patients may require permanent pacemakers to maintain a regular heart rhythm.
Special Considerations
Complete heart block can also occur as a late complication of cardiac surgery, particularly in patients with congenital heart defects such as tetralogy of Fallot or endocardial cushion defects. This delayed onset can happen months to years after the surgery, necessitating careful postoperative monitoring for conduction disturbances.
Conclusion
Complete heart block is a serious cardiac condition with various etiologies, including coronary artery disease, myocardial infarction, and fibrosis of the conduction system. Symptoms such as severe chest pain, breathlessness, and syncope are common, and the condition often requires immediate medical intervention. While some cases may be reversible, especially those associated with acute myocardial infarction, many patients will need permanent pacemakers to manage their heart rhythm. Careful monitoring and timely treatment are crucial for improving patient outcomes.
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