Heart blocks
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These studies suggest heart block involves interrupted impulses between auricles and ventricles, with treatments including pacemakers, surgical techniques, and intracardiac catheter stimulation, and it can be caused by various factors including surgery and myocardial infarction.
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Understanding Heart Blocks: Types, Causes, and Treatments
Definition and Types of Heart Blocks
Heart block is a condition where the electrical impulses that control the heartbeat are partially or completely interrupted as they travel from the atria to the ventricles. This interruption can occur at various points in the heart's conduction system, including the bundle of His and its branches. There are different types of heart blocks, including:
- First-degree heart block: The electrical signals are slowed but still reach the ventricles.
- Second-degree heart block: Some electrical signals do not reach the ventricles, leading to dropped beats.
- Third-degree (complete) heart block: No electrical signals reach the ventricles, causing the atria and ventricles to beat independently.
Causes of Heart Blocks
Coronary Artery Disease and Myocardial Infarction
Complete heart block is often associated with coronary artery disease and myocardial infarction. In cases of acute myocardial infarction, heart block can occur due to the occlusion of the right coronary artery, which supplies the atrioventricular node and bundle in most individuals . This type of heart block is frequently accompanied by other complications such as congestive heart failure and shock, leading to a poor prognosis.
Surgical Trauma
Surgical procedures for congenital heart defects can also lead to heart block. Nearly half of the patients who develop heart block during surgery may revert to sinus rhythm within a few weeks, but permanent heart block is usually due to direct trauma to the central conduction bundle . The incidence of surgical heart block has been reduced with improved surgical techniques, but it remains a significant risk.
Other Causes
Other causes of complete heart block include hypertensive heart disease, rheumatic heart disease, digitalis intoxication, and idiopathic reasons where the etiology remains undetermined.
Clinical Features and Prognosis
Symptoms
Patients with complete heart block may experience symptoms such as syncope (fainting), dizziness, palpitations, and congestive heart failure. The severity of symptoms often correlates with the underlying cause and the presence of other cardiac complications .
Prognosis
The prognosis of heart block varies depending on the underlying cause and the presence of complications. For instance, patients with complete heart block due to myocardial infarction have a higher mortality rate, especially if accompanied by shock or heart failure . Conversely, the absence of congestive heart failure is a positive prognostic sign.
Treatment Options
Pacemaker Therapy
Pacemaker insertion is a common treatment for complete heart block, especially in cases where the block is due to myocardial infarction or surgical trauma. Temporary pacemakers may be used initially, followed by permanent implantable pacemakers if the heart block persists . The use of pacemakers has significantly improved survival rates in patients with complete heart block.
Surgical Interventions
In cases of surgically induced heart block, careful surgical techniques and the use of temporary myocardial electrodes can help manage the condition until a permanent solution is found .
Conclusion
Heart block is a serious condition that can arise from various causes, including coronary artery disease, myocardial infarction, and surgical trauma. The prognosis and treatment options depend on the type and severity of the block, as well as the underlying cause. Advances in surgical techniques and pacemaker technology have significantly improved the management and outcomes of patients with heart block.
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