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atrioventricular block

ICD-10 Codes

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Description

Atrioventricular (AV) Block: A Delay in Heartbeat Conduction

Atrioventricular (AV) block, also known as heart block, is a condition where there's a delay or interruption in the electrical signal that regulates the heartbeat. This signal travels from the atria (upper chambers of the heart) to the ventricles (lower chambers of the heart), and AV block occurs when this transmission is impaired.

Types of Heart Block

There are three main types of heart block:

  • First-degree heart block: The electrical impulse still reaches the ventricles, but moves more slowly than normal through the AV node.
  • Second-degree (incomplete) heart block: The heart's impulses only get to the lower chambers some of the time.
  • Third-degree (complete) heart block: There's a complete separation of the electrical activity in the atria and ventricles, resulting in a slow or absent heartbeat.

Causes and Symptoms

AV block can be caused by various factors, including idiopathic fibrosis and sclerosis of the conduction system. Some patients may experience symptoms such as shortness of breath, chest pain, or difficulty breathing due to the heart's reduced ability to pump blood effectively.

Diagnosis and Treatment

Diagnosis is typically made through electrocardiography (ECG). Treatment depends on the degree of block and may involve pacing when necessary. In severe cases, third-degree heart block can be life-threatening and requires urgent treatment with atropine or isoprenaline and pacing.

References:

  • [1] Atrioventricular conduction is evaluated by assessing the relationship between the P waves and QRS complexes.
  • [3] Atrioventricular (AV) block is partial or complete interruption of impulse transmission from the atria to the ventricles.
  • [13] The most common cause is idiopathic fibrosis and sclerosis of the conduction system.
  • [14] Some patients may experience difficulty breathing or shortness of breath due to the heart's reduced ability to pump blood effectively.

Additional Characteristics

  • Atrioventricular (AV) block, also known as heart block, is a condition where there's a delay or interruption in the electrical signal that regulates the heartbeat.
  • First-degree heart block: The electrical impulse still reaches the ventricles, but moves more slowly than normal through the AV node.
  • Second-degree (incomplete) heart block: The heart's impulses only get to the lower chambers some of the time.
  • Third-degree (complete) heart block: There's a complete separation of the electrical activity in the atria and ventricles, resulting in a slow or absent heartbeat.
  • AV block can be caused by various factors, including idiopathic fibrosis and sclerosis of the conduction system. Some patients may experience symptoms such as shortness of breath, chest pain, or difficulty breathing due to the heart's reduced ability to pump blood effectively.

Signs and Symptoms

Common Signs and Symptoms of Atrioventricular (AV) Block

Atrioventricular (AV) block, also known as heart block, is a condition where the electrical signals that control the heartbeat are delayed or blocked. This can lead to various signs and symptoms, which can range from mild to severe.

Common Symptoms:

  • Dizziness: Many people with AV block experience dizziness or lightheadedness due to the irregular heartbeat [1][2].
  • Fainting: In some cases, the heart rate may be so slow that it leads to fainting spells [3][4].
  • Chest Pain: Chest pain is another common symptom of AV block, which can feel like pressure or tightness in the chest [5][6].
  • Shortness of Breath: People with AV block may experience shortness of breath due to the heart's inability to pump enough blood [7][8].
  • Tiredness: Fatigue and tiredness are also common symptoms of AV block, which can be caused by the heart not pumping enough blood to meet the body's needs [5][9].

Other Symptoms:

  • Palpitations: Some people may experience palpitations, which is a feeling of their heart pounding or skipping beats [2][7].
  • Nausea and Vomiting: In severe cases, AV block can lead to nausea and vomiting due to the body's inability to get enough oxygen [8].

It's essential to seek medical attention if you're experiencing any of these symptoms, especially if they are severe or come on suddenly. A healthcare professional can diagnose AV block through various tests, including electrocardiograms (ECGs) and echocardiograms.

References:

[1] Context 1: Chest pain, tiredness, shortness of breath, heart palpitations, rapid breathing, nausea, dizziness, fainting. [2] Context 2: Dizziness, fainting, feeling that your heart skips beats, chest pain, trouble breathing or shortness of breath. [3] Context 3: Wider QRS complexes, slower (20 to 40 beats/minute) and unreliable heart rates, more severe symptoms. [4] Context 5: Feeling faint; being short of breath; extreme tiredness, sometimes with confusion; chest pain. [5] Context 4: Lightheadedness or dizziness, palpitations, fatigue, chest pressure or pain, shortness of breath. [6] Context 8: Chest pain, dizziness, feeling faint or fainting, tiredness, heart palpitations. [7] Context 7: Dizziness, fainting, the feeling that your heart pauses for a beat, trouble breathing or shortness of breath, nausea. [8] Context 9: Symptoms include chest pain, dizziness, feeling faint or fainting, tiredness, heart palpitations.

Additional Symptoms

Diagnostic Tests

Diagnostic Tests for Atrioventricular (AV) Block

Atrioventricular (AV) block, also known as heart block, is a cardiac electrical disorder that affects the conduction of electrical impulses between the atria and ventricles. Diagnosing AV block requires a combination of medical history, physical examination, and various diagnostic tests.

Additional Diagnostic Tests

  • Physical Examination
  • Medical History

Treatment

Treatment Options for Atrioventricular (AV) Block

Atrioventricular (AV) block can be treated with medication, and in some cases, a pacemaker may be necessary. The goal of treatment is to alleviate symptoms and prevent complications such as syncope and sudden cardiac death.

  • Medication Adjustment: Sometimes, making changes to medications or treatment for heart disease can stop heart block [3]. This approach is often the first line of treatment.
  • Pacemaker Insertion: In more severe cases, a temporary or permanent pacemaker may be required to send electrical impulses to the heart and regulate its rhythm. Pacemaker insertion is also beneficial for patients without symptoms who have Mobitz type I second-degree AV block at infranodal sites [4].
  • Catheter Ablation of AV Block: Catheter ablation, a minimally invasive procedure, can be an effective treatment option in some cases. This procedure involves using a catheter to destroy the abnormal electrical pathway causing the heart block.

Medications Used to Treat AV Block

While medication is not always necessary, certain medications may be used to treat AV block. These include:

  • Beta blockers: Beta blockers, such as metoprolol and atenolol, can help slow down the heart rate and improve symptoms [5].
  • Calcium channel blockers: Calcium channel blockers, like verapamil and diltiazem, can also be used to treat AV block by slowing down the heart rate and improving symptoms.

Important Considerations

It's essential to note that treatment for AV block depends on the type of block and individual patient factors. In some cases, no treatment may be necessary if the block is mild or asymptomatic [8]. However, in more severe cases, a pacemaker or other interventions may be required to prevent complications.

References:

[1] Jul 13, 2022 โ€” Permanent pacing is the therapy of choice in patients with symptomatic atrioventricular (AV) block with bradycardia. [3] Sometimes, making changes to medicines or treatment for heart disease stops heart block. Other people may need a temporary or permanent pacemaker that sends ... [4] Treatment is pacemaker insertion, which may also benefit patients without symptoms who have Mobitz type I second-degree AV block at infranodal sites detected by ... [8] How is heart block treated? You treatment depends on the type of heart block you have: With first-degree heart block, you might not need treatment. With ...

Recommended Medications

  • Beta blockers
  • Calcium channel blockers

๐Ÿ’Š Drug information is sourced from ChEBI (Chemical Entities of Biological Interest) database. Always consult with a healthcare professional before starting any medication. Click on any medication name for detailed information.

Differential Diagnosis

Differential Diagnosis of Atrioventricular (AV) Block

Atrioventricular (AV) block, also known as heart block, is a condition where the electrical impulses that control the heartbeat are delayed or blocked. The differential diagnosis of AV block involves identifying other conditions that may present with similar symptoms and electrocardiographic (ECG) findings.

Conditions to Consider:

  • Sinus node dysfunction: This can cause bradycardia (slow heart rate), which may be mistaken for AV block.
  • Increased vagal tone: Vagal stimulation can lead to a decrease in heart rate, mimicking the effects of AV block.
  • Junctional rhythm: A junctional rhythm is an abnormal heart rhythm that originates from the atrioventricular node (AVN) or the bundle of His. It may be mistaken for AV block on ECG.
  • Myocardial infarction: A myocardial infarction (heart attack) can cause changes in the ECG, including ST-segment elevation and Q-waves, which may be confused with AV block.
  • Myocarditis: This is an inflammation of the heart muscle that can lead to abnormal heart rhythms, including AV block.
  • Second-degree atrioventricular block: This is a type of AV block where some P waves are not followed by a QRS complex, making it difficult to distinguish from complete AV block.

Key Points:

  • The differential diagnosis of AV block involves considering other conditions that may present with similar symptoms and ECG findings.
  • A thorough history and physical examination, along with careful analysis of the ECG, is essential for accurate diagnosis.
  • In some cases, further testing such as an electrophysiology study (EPS) may be necessary to confirm the diagnosis.

References:

  • [1] Jul 13, 2022 โ€” Mobitz I and Mobitz II atrioventricular (AV) block must be differentiated from sinus node dysfunction and increased vagal tone.
  • [8] Nov 14, 2022 โ€” Atrioventricular block can be differentiated from atrioventricular dissociation, junctional rhythm, and multifocal atrial tachycardia based on ECG findings.
  • [9] by P Alboni ยท 2013 ยท Cited by 112 โ€” Differential diagnosis with intrinsic AV block is based on the behaviour of the sinus rate. Vagally mediated AV block is benign; it can be recorded as an ...

Additional Information

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