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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Heart block is defined as impaired or abnormal conduction of electrical impulses in the heart. With each heartbeat, an electrical signal spreads across the heart from the upper (atria) to the lower chambers (ventricles). As it travels, the signal causes the heart to contract and pump blood. This process repeats with each new heartbeat. Heart block occurs if the electrical signal is slowed or disrupted as it moves from the upper to the lower chambers of the heart. This abnormality can occur in the heart muscle (myocardium) or in the specialized electrical conduction system of the heart.
A heart block can be a blockage at any level of the electrical conduction system of the heart:
Clinically speaking, most of the important heart blocks are AV nodal blocks and Infra-Hisian blocks.
The SA nodal blocks rarely give symptoms. This is because if an individual had complete block at this level of the conduction system (which is uncommon), the secondary pacemaker of the heart would be at the AV node, which would fire at 40 to 60 beats a minute, which is enough to retain consciousness in the resting state.
Types of SA nodal blocks include:
In addition to the above blocks, the SA node can be suppressed by any other arrhythmia that reaches it. This includes retrograde conduction from the ventricles, ectopic atrial beats, atrial fibrillation, and atrial flutter.
The difference between SA node block and SA node suppression is that in SA node block an electrical impulse is generated by the SA node that doesn't make the atria contract. In SA node suppression, on the other hand, the SA node doesn't generate an electrical impulse because it is reset by the electrical impulse that enters the SA node.
There are four basic types of AV nodal block:
Infrahisian block describes block of the distal conduction system. Types of infrahisian block include:
Of these types of infrahisian block, Mobitz II heart block is considered most important because of the possible progression to complete heart block.
Damage to the heart muscle and its electrical system by diseases, surgery, or medicines can cause acquired heart block. Heart block can be either congenital or acquired. Acquired heart block is more common than congenital heart block.
The risk factors for congenital and acquired heart block are different.
Cardiovascular | No underlying causes |
Chemical/Poisoning | No underlying causes |
Dental | No underlying causes |
Dermatologic | No underlying causes |
Drug Side Effect | Aprotinin, , Fosphenytoin sodium, Interferon gamma, Methacholine, Pergolide |
Ear Nose Throat | No underlying causes |
Endocrine | No underlying causes |
Environmental | No underlying causes |
Gastroenterologic | No underlying causes |
Genetic | No underlying causes |
Hematologic | No underlying causes |
Iatrogenic | No underlying causes |
Infectious Disease | No underlying causes |
Musculoskeletal/Orthopedic | No underlying causes |
Neurologic | No underlying causes |
Nutritional/Metabolic | No underlying causes |
Obstetric/Gynecologic | No underlying causes |
Oncologic | No underlying causes |
Ophthalmologic | No underlying causes |
Overdose/Toxicity | No underlying causes |
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 |
Symptoms depend on the level of the heart block:
Heart block is considered an absolute contraindication to the use of the following medications: