Trystan Casey
Heart block, or cardiac conduction disorder, is a condition that affects the electrical system of the heart, causing it to beat irregularly and slower than usual. This can lead to serious complications such as cardiac arrest and even death. There are three types of heart block: first-degree, second-degree, and third-degree, with the third being the most severe and requiring immediate medical attention. Heart block can be caused by various factors, including congenital defects, ageing, and certain medications. Understanding the causes and treatment options for heart block is crucial to prevent adverse outcomes and ensure the well-being of those affected.
| Characteristics | Values |
|---|---|
| Type | Heart block, conduction disorder |
| Cause | Injury or damage to heart muscle or valves, congenital, certain medications, coronary artery disease, heart attack, heart disease, heart failure, advancing age, fibrosis, any process that can damage electrical signals |
| Symptoms | Chest pain, fainting, dizziness, skipped or irregular heartbeats, trouble breathing, fatigue, slow heart rate, cardiac arrest, loss of consciousness |
| Diagnosis | ECG, Holter monitor, cardiac event monitor, implantable loop recorder, electrophysiology study, medical history, family history, lifestyle and medication review |
| Treatment | Pacemaker, medication changes, underlying condition treatment |
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Heart block
There are three types of heart block categorised by severity: first-degree, second-degree, and third-degree. People with first-degree heart block may not experience any symptoms and can usually continue their normal activities without requiring treatment. However, it is still important to consult a medical professional for advice. Second-degree heart block may require a pacemaker, especially if symptoms are present or if Mobitz II heart block is detected.
Third-degree heart block, also known as complete heart block, is the most severe form. It occurs when there is a total blockage of electrical signals, resulting in a very slow or absent pulse. This type of heart block can be life-threatening and usually requires immediate treatment with a pacemaker. Symptoms of third-degree heart block include chest pain, shortness of breath, heart palpitations, rapid breathing, and fainting. Without treatment, severe heart block can lead to lightheadedness, fainting spells, and even cardiac arrest.
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Bundle branch block
In a healthy heart, electrical impulses are generated in the sinoatrial node (SA node) or the heart's natural pacemaker, which is situated in the upper right atrium. These impulses then travel through the left and right atria and summate at the atrioventricular node (AV node). The AV node checks the impulse and sends it along a track called the bundle of His, which divides into the right and left bundle branches leading to the heart's lower chambers or ventricles.
In bundle branch block, the electrical impulses are blocked or delayed as they travel through the bundle branches, causing one ventricle to contract a fraction of a second slower than the other. This results in an abnormal or irregular heartbeat. While some people with BBB may not experience any symptoms, others may faint or feel as if they are going to faint.
BBB can be classified as right bundle branch block or left bundle branch block, depending on which branch is affected. The former can occur even in a healthy heart, while the latter is associated with a higher risk for heart disease. The simultaneous occurrence of both types of BBB leads to a total AV block. Underlying causes of BBB include heart disease, high blood pressure, coronary artery disease, cardiomyopathy, and valve disease.
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Long QT syndrome
LQTS can be inherited or acquired. Inherited LQTS is a lifelong condition, and those affected are born with the disorder. It is often associated with a family history of heart-related issues and can be identified through genetic testing. On the other hand, acquired LQTS is the result of conditions, medications, or events that prolong the QT interval. This form of LQTS may be resolved by discontinuing the medication or treating the underlying condition.
LQTS can cause abnormal heart rhythms in response to exercise or stress. The heart's lower chambers take longer to contract and release, resulting in inefficient blood pumping. While not everyone with LQTS experiences dangerous heart rhythms, those who do are at risk of fatal arrhythmias and sudden cardiac arrest. LQTS may also lead to fainting spells, and the risk of these complications tends to decrease with age, especially in men over 40.
Diagnosis of LQTS involves a comprehensive evaluation, including a review of medical history, family medical history, symptoms, and medications. Blood tests, genetic testing, and heart tests such as EKGs and stress tests, are also employed to confirm the condition. Treatment focuses on preventing arrhythmias and fainting spells, although it may not restore a normal QT interval.
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Sick sinus syndrome
In sick sinus syndrome, the electrical signals are irregularly paced. The heartbeat can be too fast, too slow, or a combination of both. It can also cause problems with increasing the heart rate when needed, such as during exercise. This syndrome is caused by impaired pacemaker function and impulse transmission, resulting in abnormal rhythms. These abnormal rhythms include atrial bradyarrhythmias, atrial tachyarrhythmias, and sometimes bradycardia alternating with tachycardia, often referred to as "tachy-brady syndrome".
There are several known causes of sick sinus syndrome. It is primarily a disease of the elderly, caused by degeneration of the SA node, affecting its ability to generate or transmit impulses to the atrial tissue. Other causes include injury or breakdown of the heart's electrical route or SA node due to aging, surgery, certain medications, genetics, metabolic problems, and other heart conditions such as heart failure.
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Medication
If medication is causing the heart block, changing or stopping the medication may resolve the issue. Doctors may prescribe atropine, which can improve the conduction of electrical signals throughout the heart, or isoproterenol, dopamine, dobutamine, or epinephrine if atropine is not effective.
It is important to note that not all medications will cause heart block in everyone, and that heart block can be caused by other factors such as age, genetics, or other health conditions.
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Frequently asked questions
A heart block, or a cardiac conduction disorder, is a problem with the electrical system that controls the heart's rate and rhythm. It occurs when electrical signals do not travel between the upper and lower chambers of the heart, resulting in a slower and more irregular heartbeat.
Symptoms of a heart block vary depending on its severity. Some people may experience no symptoms at all, while others may suffer from chest pain, fainting, dizziness, irregular heartbeats, trouble breathing, fatigue, or even cardiac arrest.
Heart blocks can be congenital or acquired. Congenital heart blocks are present at birth and may be caused by a condition the mother had during pregnancy or heart defects the baby is born with. Acquired heart blocks, on the other hand, can develop over time due to various factors such as age, injury, or damage to the heart muscle, valves, or electrical signals. Certain medications can also contribute to heart blocks by slowing down electrical impulses.
