AV block 1st degree characteristic ECG signs. Congenital or acquired atrioventricular block: degrees of disease development, treatment

AV block is a cardiac pathology accompanied by disturbances in heart rhythm and hemodynamics. It develops as a result of disruption of the passage of nerve impulses through the conduction system of the heart, which leads to asynchronous functioning of the atria and ventricles. The most common and frequently diagnosed is 2nd degree AV block, in which partial conduction impairment is observed. The 1st degree is characterized by a slowdown in the passage of impulses through the nerve fibers, and at the 3rd degree it stops completely.

Atrioventricular block - dysfunction of the conduction of electrical impulses between the atria and ventricles

Causes of the disease

Atrioventricular block can be functional or organic in nature. Organic disorders are associated directly with the heart, and functional ones arise against the background of pathological processes in the parasympathetic node. The following reasons are possible:

• Nocturnal activity of the vagus nerve. The disorder develops during the rest period in young people who play sports and lead an active lifestyle. IN in this case conduction disturbance is temporary and is considered normal. This is due to the fact that at night the vagus nerve works more actively than at night. daytime days.
• Cardiac. The cause of development is sclerotic and idiopathic lesions of the conduction system. They develop against the background various diseases hearts. At the very beginning, the disorder is partial, then complete AV block develops.

Most often, the pathology is acquired

• Poisoning. Blockades can develop as a result of acute intoxication of the body when consumed medicines and poisons.
• Damage to the conduction system of the heart during surgical interventions. Heart surgery can cause damage to nerve fibers or bundles, causing cardiac conduction problems.
• Congenital. This pathology is rare. Infants born with this disease partially lack conducting areas, which causes the development of pathology.

Signs of deviation

The intensity and nature of the pathology depends on the degree of the disease. 1st degree AV block can be completely asymptomatic, in which case it is difficult to diagnose.

Stage 1 disease may reduce exercise tolerance

With this pathology, the localization of the process is of great importance. If it is located in the area of ​​the atrioventricular node without symptoms of bradycardia, then it is impossible to detect it by clinical signs. Severe symptoms can occur when the number of heart contractions decreases; against their background, lethargy, weakness and shortness of breath may occur when physical activity. This is due to hypoxia due to insufficient volume of blood being ejected. Slowing of AV conduction may be accompanied by periodic dizziness, weakness and loss of consciousness.

2nd degree AV block is characterized by a lack of synchrony in the functioning of the atria and ventricles, which results in a feeling of heart rhythm disturbance and arrhythmias develop.

When a grade 3 disorder occurs, the patient's heart rate decreases, he feels weak, may faint, pain occurs in the heart area, and the mucous membranes and skin become bluish.

Patients with 2nd degree atrioventricular block often complain of arrhythmia

Types of AV blocks

All atrioventricular blocks are conventionally divided into partial and complete. Depending on the nature of the pathology, they can be permanent or temporary. All of them are divided into three groups, depending on the localization and intensity of impulse conduction disturbances from the atrioventricular node in the atria to the bundle and branches of His in the ventricles. Features of the forms are reflected in the table.

Diagnostic methods

The diagnosis is made based on medical history, electrocardiogram, cardiac auscultation and additional studies. A history of heart disease, poisoning, or taking certain medications may raise suspicion for the development of AV block.

Based on the ECG results, a cardiologist can identify pathology and determine the degree of its development

When listening to the heart, the rhythm is not disturbed, but long pauses appear, which indicate loss of ventricular systole. During the blockade, pronounced bradycardia and Starzhesko's cannon tone are detected.

The most effective test in making a diagnosis is an ECG, which allows you to diagnose AV block and accurately determine its type.

1st degree AV block on the ECG is detected as a prolongation of the interval between contractions of the atria and ventricles, while all other indicators remain normal. Other forms of pathology have their own characteristic changes in the results of the study. First degree AV block on the ECG looks like a complete lack of connection with the performance of the atria and ventricles.

If other cardiac pathologies accompanying the disease are detected, cardiac ECHO, ultrasound and MRI are prescribed. For monitoring general condition the patient is prescribed additional research blood and urine.

When conducting diagnostics in a patient with pathology, the periodic appearance of a loud first tone is heard

Treatment options

Therapy can be carried out in the following ways:

• First degree atrioventricular block has no specific treatment; symptomatic treatments are prescribed. healing procedures to normalize the patient's condition.
• The blockade caused by intoxication of the body is eliminated with the help of neutralizing therapy.
• The occurrence of pathology against the background of myocardial diseases requires the prescription of adrenergic stimulants to resume the conduction of cardiac impulses.
• To eliminate the pathology, a procedure for implanting cardiac stimulators can be used. The technique is a radical solution to the problem and is indicated for diagnosing 3rd degree AV block.
• When edema develops, diuretics, vasodilators and cardiac glycosides are prescribed.

If symptoms of AV block are detected, you should consult a specialist to determine the exact cause and treatment of intra-atrial conduction disturbance. To relieve an attack, it is recommended to administer Atropine to the patient and give an Isoprenaline tablet. After cupping dangerous condition the patient should be rushed to hospital.

Pathology of the 1st degree does not require special therapy, as a rule.

Possible complications

AV heart block of the 1st degree is the least dangerous for the development of complications. Stages 2 and 3 of the disease lead to more significant changes in the patient’s condition. The main problem is the development of pathologies associated with regular cardiac conduction disorders. This leads to the development of heart failure and its exacerbation chronic forms. The lack of synchronous functioning of the heart leads to the body compensating for heart failure with arrhythmias and ventricular tachycardia.

The third degree of the disease is the most dangerous. During attacks, hypoxia of brain tissue and other organs may occur, which leads to the development of serious pathologies internal organs. A long-term lack of brain power can cause the death of neurons and the death of the patient. During severe attacks, the patient may need resuscitation measures to save life.

Doctors give a favorable prognosis to a patient with stage 1 disease

AV block on the ECG manifests itself in the form of disturbances in the coordination of the heart, which can cause the development of other cardiac pathologies.

Prevention of pathology

Violation of intracardiac conduction is associated with a number of factors; to prevent the development of the disease, it is recommended to promptly identify and prescribe treatment for cardiac pathologies. This will avoid the development of a blockade.

1st degree AV block is the initial stage of the disease, which is asymptomatic. With timely detection and treatment, the development of grades 2 and 3 of the disease can be avoided.

To prevent the development of complete AV block, implantation of a pacemaker in the early stages is recommended. This will avoid aggravation pathological process and improve the patient's quality of life.

From the video you will learn more about atrioventricular block, its symptoms and treatment methods:

The heart obeys the rhythm set by the sinus node. Arrhythmias and heart blocks occur due to the fact that the impulse does not pass correctly through the conduction system of the heart. The ventricles and atria cannot contract rhythmically and coherently, so disruptions occur in the functioning of the myocardium, blood supply to the brain and other organs. Such arrhythmia can cause serious diseases or indicate existing ones.

The mechanism of development of the problem

A healthy heart obeys a clear rhythm, which is set by electrical impulses. The impulse appears in the sinus node, first contracts the atria, then the ventricles, providing an optimal rhythm with a frequency of 60-80 beats/min. At the same time, optimal blood pressure and oxygen saturation of organs are maintained. Heart block occurs when an impulse does not travel its full path through the conduction system. Then an extra blow occurs or, conversely, the contraction “falls out”. Consequently, blockade is a subtype of arrhythmia, which characterizes conditions with disruption of the excitability, conductivity and rhythm of heart contractions.

If the pulse increases due to arrhythmia, tachycardia occurs; if it decreases, bradycardia occurs. There are several types of heart blockades, depending on how and where the impulse conduction is disrupted. The types of disease are presented in the table:

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Reasons for the development of arrhythmia and blockade

The most common consequences that lead to arrhythmia are wrong image life (alcoholism, smoking, abuse of strong caffeine-containing drinks, frequent stress, uncontrolled use of medications), diabetes, heart diseases. After a myocardial infarction, due to residual scars, the impulse cannot be transmitted correctly, which also causes arrhythmia.

Sometimes arrhythmia is congenital and inherited.

If a person is healthy and there are no external factors that provoke arrhythmia, this disease itself cannot appear. However, there are certain risk factors. For example, some types of arrhythmias are congenital and are transmitted genetically. Diseases thyroid gland affect the level of hormones in the blood, which changes metabolism. When complete blockade and atrial fibrillation or flutter are combined, severe Frederick's syndrome develops, in which the rhythm decreases to 20 beats/min. The attack is characterized by fainting and convulsions against the background of cerebral ischemia. Such attacks are called Adams-Morgagni-Stokes phenomena. In the absence of help, the outcome is fatal.

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Diagnostic methods

Arrhythmia and heart block are diagnosed using an electrocardiogram (ECG). For each type and type of disease, the ECG waves look different, which allows the doctor to assess the state of systoles (contractions). Rhythm disturbances are audible when measuring pressure with a mechanical tonometer. The automatic device will indicate the number of heart contractions, which normally should be from 60 to 80 beats/min.

First degree blockade and partial blockade manifest themselves only on the ECG. They may be accompanied by some weakness and dizziness. As it develops, rhythm disturbances, freezing or fluttering of the heart, nausea, dark spots or dots before the eyes are felt. Such deterioration can occur suddenly, quickly replacing periods of good health. These symptoms may last for a long time. With complete blockade, loss of consciousness is possible, which is preceded by a rare pulse, pallor and cold sweat. Epileptiform seizures are possible. If they occur regularly, they lead to brain hypoxia and death. It is important not to delay visiting a doctor if symptoms appear.

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Treatment of arrhythmia and heart block

For partial blockades of the 1st and 2nd degree drug treatment, is generally not used. Most often, this disease is concomitant, so the underlying disease is treated. The recommendations are aimed at organizing healthy image life, moderate physical activity. Walking in the fresh air is beneficial. You definitely need to give up alcohol, smoking, and strong coffee. Treatment of arrhythmia is prescribed only by a specialist. If drug treatment does not help, pacing may be necessary.

If symptoms of 3rd degree blockade appear, you should immediately call ambulance. At this time, it is important to place the patient on a hard, flat surface; if there is no pulse, do indirect massage hearts. If you lose consciousness, perform artificial respiration. Brigade emergency care carries out resuscitation measures, the doctor will decide on the need for constant stimulation. Surgery may be needed.

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1. Why is the crisis developing?
2. What crises are there?
3. Clinical picture
4. First aid
5. Necessary activities
6. Emergency supplies
7. What to do in severe cases
8. Conclusion

Every person prone to high blood pressure has a chance to find out from his own experience what it is. hypertensive crisis. It is also called hypertensive. This is understood as a sharp rise in pressure, which is accompanied by characteristic clinical symptoms. This condition is dangerous and requires an urgent but controlled reduction in pressure. Otherwise, vital organs may be damaged.

The diagnostic criterion for this condition is an increase in pressure above 180/120 mm Hg. Art. Sometimes one of the indicators reaches high numbers. But there are cases when the corresponding symptoms are observed at lower values.

Why is the crisis developing?

The reasons why a hypertensive crisis develops are divided into external (exogenous) and internal (endogenous).

TO external factors include:

• sudden cessation of medications that control blood pressure;
• excessive salt intake;
• strong psycho-emotional stress - stress;
• excessive drinking of alcohol;
• changing weather conditions accompanied by changes in atmospheric pressure;
• reception hormonal contraceptives, NSAIDs, glucocorticoids, B-adrenergic agonists and other drugs that increase blood pressure;
• acute hypoxia of the brain as a result of a sharp decrease in pressure caused by the action of drugs;
• resuscitation measures during and after operations.

Endogenous reasons may be the following:

• sudden disruption of kidney function, which is accompanied by increased production of renin;
• hormonal changes in women during menopause;
• progressive deterioration of the condition in patients with coronary artery disease, which is manifested by the development of heart attack, cardiac asthma;
• cerebral ischemia leading to compensatory hypertension;
• disorders in the organs of the urinary system (kidneys) against the background of prostatic hyperplasia;
• secondary hyperaldosteronism;
• psychogenic hyperventilation – breathing disorders;
• crisis in sickle cell anemia;
• sleep apnea syndrome - stopping breathing during sleep.

Hypertensive crises are usually associated with a sudden increase in vascular tone - arterioles - under the influence of vasoconstrictor factors or as a result of sodium retention. Another reason may be an increase in heart rate, myocardial contractility, or a change in the volume of circulating blood towards its increase.

The severity of the condition is largely determined by the rate of increase in pressure, and not by its numbers. If the pressure grows quickly, then the mechanisms responsible for its stabilization do not have time to turn on.

A hypertensive crisis is accompanied by an increase in pressure in the blood vessels of the brain. Reflex narrowing of the arteries helps compensate for this. And normal blood flow is maintained for some time. Fast promotion pressure may be accompanied by rupture of the vascular wall and hemorrhage. Arterial spasm is dangerous for the development of cerebral ischemia. The vessels cannot remain in good shape for a long time, so the spasm is replaced by their dilatation (expansion). Vascular permeability increases, fluid rushes into the brain tissue, and brain edema develops. Symptoms of encephalopathy appear.

Hypertensive crises do not pass without leaving a mark on the heart and large arterial vessels. Increased load and increased myocardial oxygen demand with concomitant ischemic heart disease can be accompanied by attacks of anginal pain up to the development of a heart attack. Acute left ventricular failure may occur. Heart rhythm may be disturbed.

On the background high pressure rupture of blood vessels and the appearance of symptoms such as nosebleeds and the formation of a dissecting aortic aneurysm are possible. With repeated crises, the kidneys may also suffer.

What crises are there?

Depending on the characteristics of clinical manifestations, hypertensive crises are divided into two types:

1. Hyperkinetic (neurovegetative, adrenal, type 1) - develops due to activation of the sympathoadrenal system. It is characterized by a sudden onset, violent vegetative symptoms: redness of the face, rapid heartbeat, sweating. Maybe frequent urination. This is a more favorable option, although the appearance of chest pain typical of angina, rhythm disturbances and the development of myocardial infarction are possible. The duration of the attack is from 2 to 4 hours.
2. Hypokinetic (edematous, norepinephrine, type 2) – the clinical picture increases gradually, the skin is pale, patients are adynamic. In this case, there is a significant increase in lower pressure. Symptoms of brain and heart damage come to the fore. They flow hard. This condition can persist for several days. Such crises are observed in the later stages of the disease and with initially higher blood pressure values.

Currently, the generally accepted classification is that a hypertensive crisis can be complicated or uncomplicated.

The first option includes crises that are accompanied by the development of:

• acute necrosis of the heart muscle (infarction);
• hypertensive encephalopathy;
• ischemic stroke;
• acute left ventricular failure with symptoms of cardiac asthma and pulmonary edema;
• dissecting aortic aneurysm;
• hemorrhages under the membranes of the brain or in the brain;
• transient ischemic attacks.

Crises of any type are considered complicated in pregnant women with eclampsia and preeclampsia (late toxicosis), with traumatic brain injuries, bleeding, and with the use of drugs and amphetamines. Requires hospitalization and treatment in a hospital setting.

An uncomplicated hypertensive crisis is milder and usually does not pose a serious threat to life. No emergency transport to hospital is required. Treatment should result in a slow decrease in blood pressure over several hours.

Clinical picture

The signs of a hypertensive crisis, regardless of the cause and variant, are quite typical. This is a relatively unexpected start. Blood pressure may rise within minutes or hours. The pressure level is individually high.

Signs of brain distress:

• intense headaches and dizziness;
• nausea, sometimes ending in vomiting;
• visual disturbances: there is often double vision, temporary blindness is possible, but more often flies flash before the eyes or a veil appears;
• sensitivity disorders: the face may become numb, decreased pain sensitivity in the area of ​​the face, lips, tongue, there is a feeling that goosebumps are crawling;
• movement disorders: possible mild weakness in distal sections hands, transient (up to a day) hemiparesis - paralysis of one side of the body;
• possible temporary speech difficulty - aphasia;
• Rarely, but there are seizures.

Most of these symptoms are due to the development of hypertensive encephalopathy.

A hypertensive crisis also adversely affects the heart. The following symptoms are characteristic:

• pain in the precordial region;
• rhythm disturbances - rapid heartbeat, interruptions in heart function;
• shortness of breath appears.

Autonomic disorders are often observed:

• chills or feeling of heat appear;
• there is tremors in the limbs;
• characterized by irritability;
• a feeling of fear appears;
• sweating and thirst are possible;
• After an attack, copious amounts of urination often occur.

The main signs of a hypertensive crisis are a triad of symptoms: headache, dizziness and nausea. Other symptoms may be observed in various combinations or absent altogether. But every person should know what to do in such a situation.

First aid

Hypertensive crisis must be treated promptly. This should be done correctly, otherwise you may get severe complications. If the crisis is uncomplicated, then you can try to cope with it yourself. Medicines in tablets are used for treatment. A slow decrease in blood pressure, by an average of 25% during the first two hours, is considered optimal. It should stabilize within 24 hours.

Necessary activities

1. Calm down. Panic can only make an already difficult situation worse.
2. It is better to sit down or take a half-sitting position.
3. You can prepare a basin of hot water and put your feet in it. As an alternative, you can use mustard plasters, which are fixed in the area calf muscles. You can use a heating pad.
4. Open a window to provide fresh air.
5. Take medicine to lower your blood pressure. It is advisable to use the remedy that the doctor recommends in this case.
6. Call an ambulance.

Emergency supplies

If a person suffers from hypertension, then medications to quickly lower blood pressure should always be on hand. The same tools are used by emergency doctors in similar cases. You need to take the pills as soon as your blood pressure reaches critical values ​​and the corresponding symptoms appear.

1. Captopril is an ACE inhibitor. Begins to act in 5 minutes. The effect lasts on average about 4 hours, rarely longer. A 25 mg tablet is placed under the tongue and kept there until completely absorbed. Some patients report an unpleasant tingling sensation under the tongue. The dose can vary from half a tablet to 2. It all depends on the blood pressure. The drug is indicated for any type of crisis. Not for use in pregnant women, for the treatment of nursing women and persons under 18 years of age.
2. Nifedipine is a calcium channel blocker. It can also be found under other names: phenigidine, corinfar, cordaflex, cordipin. The effect occurs 15–20 minutes after oral administration and 5 minutes after sublingual (under the tongue) use. The drug is effective for a maximum of 6 hours, with an average of 4 hours. Tablets have a standard dose of 10 mg. They can be placed under the tongue or simply chewed. To relieve high blood pressure, you may need from 1 to 4 tablets. It is undesirable to use the drug during type 1 crises, since nifedipine causes tachycardia, characterized by redness of the facial skin. In case of severe atherosclerosis, it is better not to take the drug.
3. Clonidine (clofedine) is a centrally acting drug. After sublingual administration, the pressure begins to decrease within 10–15 minutes. The action ends after 2–4 hours. The recommended dose is 0.15 or 0.075 mg. It is permissible to take no more than 2.4 mg per day. The use of the drug is not recommended for significant atherosclerotic vascular damage, which is especially common in older people. Contraindications are: severe bradycardia, heart block, pregnancy and lactation.
4. Propranolol (anaprilin) ​​is a drug from the group of non-selective B-blockers. After oral administration, the hypotensive effect is observed within 30–60 minutes and lasts up to 4 hours. Tablets come in 10 or 40 mg. It's better to start with a lower dose. This is the most effective remedy in type 1 crises, accompanied by tachycardia and severe vegetative symptoms. The drug is contraindicated in severe heart failure, bradycardia and heart block.
5. Moxonidine is a centrally acting drug. Other names of the medicine: physiotens, moxonitex, moxarel, tenzotran. It is an excellent alternative to clonidine, since the latter can only be obtained with a special doctor’s prescription. A 0.2 or 0.4 mg tablet is used on the tongue. It acts quickly and for a long time, more than 12 hours. Contraindications are similar to clonidine, but the list can be supplemented with conditions such as Parkinson's disease, epilepsy and glaucoma.

When using medications, individual intolerance should be taken into account.

When the pressure stabilizes, treatment of hypertension continues with the usual means. After a hypertensive crisis has occurred, you should definitely consult your doctor. In consultation with the doctor, treatment can be changed.

What to do in severe cases

If symptoms appear that indicate the development of complications, then the ambulance team is involved in treatment. Before starting treatment, the doctor will definitely do an electrocardiogram to rule out acute cardiac pathology, talk to you and provide first aid.

Medicines are administered intravenously. This may be clonidine, enalaprilat, propranolol, furosemide (Lasix), urapidil (Ebrantil). Nitroglycerin is used according to indications. It is extremely rare to resort to drugs such as sodium nitroprusside or phentolamine. Such patients should not stay at home.

Indications for hospitalization:

• the first crisis;
• if crisis conditions are repeated many times;
• crisis, which began to be treated at the prehospital stage, but this did not bring a positive effect;
• the appearance of symptoms of hypertensive encephalopathy;
• development of complications requiring intensive treatment and constant medical supervision;
• malignant arterial hypertension.

Patients are hospitalized in the therapy or cardiology department. If a stroke develops, treatment is carried out in the neurology department.

Conclusion

Every person who suffers arterial hypertension, as well as his relatives, must clearly understand the dangers of a hypertensive crisis. You need to be prepared for this. However, it is much more important to prevent exacerbations hypertension, manifested in the form of such pressure surges.

To do this, you need to remember the reasons that provoke an increase in pressure in order to exclude them. It is necessary to understand the basic symptoms and first aid methods. But most importantly, you should regularly follow the recommendations of your doctor and do not try to experiment with medications. You cannot cancel treatment on your own. Any mistake can cost your life.

When the conduction of electrical impulses through the AV node is impaired, atrioventricular block develops, the degree of which can vary. Her ECG and clinical manifestations. In most cases, the pathology does not cause a serious deterioration in well-being. It requires mandatory diagnosis using daily monitoring ECG.

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What is

Normally, the impulse generated in the sinus node travels along the atrial pathways, exciting the atria. Then it enters the atrioventricular (AV), that is, the atrioventricular node, in which its conduction speed drops sharply. This is necessary so that the atrial myocardium contracts completely and blood enters the ventricles. The electrical signal then travels to the ventricular myocardium, where it causes them to contract.

With pathological changes in the AV node caused by heart disease or autonomic stress nervous system, the passage of the signal through it slows down or stops altogether. A conduction block occurs from the atria to the ventricles. If the impulses still pass into the ventricular myocardium, this is an incomplete atrioventricular block.

A complete blockade, when the atria contract normally, but not a single impulse penetrates the ventricles, is much more dangerous for health. The latter are forced to “connect backup sources” of impulses lying below the AV connection. Such pacemakers operate at a low frequency (from 30 to 60 per minute). At this rate, the heart cannot provide the body with oxygen, and clinical signs of pathology arise, in particular, fainting.

The incidence of AV block increases with age. Complete blockade is observed mainly in people over 70 years of age, in 60% of men. It can also be congenital, and then the ratio of girls to boys is 3:2.

Classification of pathology

AV block is classified according to ECG signs that reflect electrical processes in the heart. There are 3 degrees of blockade. The 1st degree is accompanied only by a slowdown in the conduction of the impulse through the AV node.

With the 2nd degree of blockade, the signals are increasingly delayed in the AV node until one of them is blocked, that is, the atria are excited, but the ventricles are not. With the regular loss of every 3rd, 4th, and so on, contractions speak of AV block with Samoilov-Wenckebach periodicity or Mobitz-1 type. If the impulse block occurs irregularly, it is AV block without the specified periodicity or Mobitz-2 type.

With the loss of every 2nd complex, a picture of 2nd degree AV block appears with 2:1 conduction. The first digit in this regard indicates the number of sinus impulses, and the second - the number of signals transmitted to the ventricles.

Finally, if electrical signals from the atria do not travel to the ventricles, third degree atrioventricular block develops. It is characterized by the formation of replacement rhythms, causing the ventricles to contract, albeit slowly.

First degree blockade

All impulses emanating from the sinus node enter the ventricles. However, their conduction through the AV node is slow. Wherein P-Q interval on the ECG is more than 0.20 s.

Second degree blockade

Atrioventricular block of the 2nd degree with Wenckebach periodicity manifests itself on the ECG as progressive extension P-Q followed by the appearance of a single non-conducted P-wave, resulting in a pause being recorded. This pause is shorter than the sum of any two consecutive R-R intervals.

An episode of Mobitz-11 type blockade usually consists of 3 to 5 contractions with the ratio of impulses generated and conducted into the ventricles as 4:3, 3:2, and so on.

The ventricles contract under the influence of the replacement rhythm, which is generated in the upper part of the His bundle, either in its legs, or in even smaller pathways. If the source of the rhythm is in the upper part of the His bundle, then the QRS complexes are no wider than 0.12 s, their frequency is 40 - 60 per minute. With an idioventricular rhythm, that is, formed in the ventricles, the QRS complexes have an irregular shape, they are widened, and the heart rate is 30 - 40 per minute.

Diseases associated with infiltration of the heart muscle by pathological tissues that impede conduction through the AV node:

• sarcoidosis;

• hypothyroidism;

• hemochromatosis;

• Lyme disease;

The degree of AV conduction may also be affected by systemic diseases: ankylosing spondylitis and Reiter's syndrome.

Iatrogenic causes of AV block (related to medical intervention):

• prosthetics aortic valve;

• surgeries for hypertrophic cardiomyopathy;

• correction birth defects hearts;

• some medications: digoxin, beta blockers, adenosine and other antiarrhythmics.

Symptoms

Clinical signs atrioventricular block depend on its degree.

With a 1st degree block, there are no symptoms, and conduction disturbances are detected only on an ECG. In addition, it can occur exclusively at night.

2nd degree blockade is accompanied by a feeling of interruptions in the heart. With complete AV block, the patient experiences weakness, dizziness, fainting, and a rare heartbeat.

The patient also experiences symptoms of the underlying disease (chest pain, shortness of breath, swelling, instability of blood pressure, and others).

Treatment

AV block is not a disease, but only one of the manifestations of any cardiac pathology. Therefore, therapy begins with treatment of the underlying disease (myocardial infarction, etc.).

First degree AV block and asymptomatic second degree block do not require treatment. You just need to stop using medications that impair AV conduction.

If atrioventricular block on the ECG is accompanied by signs oxygen starvation brain, medical attention is needed.

A remedy for quickly accelerating heart rate, but it is not always effective. In these cases, temporary cardiac pacing is used.

Treatment of third degree atrioventricular block consists of: Depending on the type of blockade, atrial-dependent ventricular pacing or on-demand ventricular pacing may be used.

In the first case, the device is adjusted in such a way that contraction of the atria is artificially carried out to the ventricles. In the second, the stimulator impulse is applied directly to the ventricular myocardium, causing them to contract rhythmically at the desired frequency.

Forecast

This conduction disorder can cause the following complications:

• sudden death due to cardiac arrest or ventricular tachycardia;

• cardiovascular failure with fainting, exacerbation of coronary artery disease or congestive heart failure;

• head or limb injuries during...

When a pacemaker is implanted, all these unpleasant consequences are eliminated.

Scientists have proven that first degree AV block is associated with increased risk occurrence, the need for pacing, heart failure and mortality from any cause.

With congenital AV block, the prognosis depends on the heart defect that caused the disorder. With timely surgical intervention and implantation of a pacemaker, the child grows and develops normally.

About what AV block is, symptoms, complications, watch this video:

Prevention

Prevention of AV block is associated with general measures prevention of heart disease:

• healthy eating;

• maintaining normal weight;

• daily physical activity;

• control blood pressure, cholesterol and blood sugar levels;

• cessation of alcohol abuse and smoking.

Patients with 1st degree blockade should avoid medications that worsen AV conduction, primarily beta blockers (, atenolol, metoprolol and others).

Secondary prevention of blockade complications is the timely installation of a pacemaker.

Atrioventricular block is a violation of the conduction of impulses from the atria to the ventricles. In mild cases it is asymptomatic. However, the 3rd degree of such blockade can lead to fainting and injury, as well as complicate the course of cardiac pathology. The main treatment method for advanced AV block is. This device causes the heart to work in a normal rhythm, and all manifestations of conduction disorders disappear.

Read also

The detected bundle branch block indicates many abnormalities in the functioning of the myocardium. It can be right and left, complete and incomplete, branches, anterior branch, two- and three-bundle. Why is blockade dangerous in adults and children? What are the ECG signs and treatment? What are the symptoms in women? Why was it detected during pregnancy? Is bundle block block dangerous?

In order for the heart to provide blood to every cell of the body, it must contract in the correct rhythm and at a frequency of 55-60 to 80-90 beats per minute. The rhythm must be regular, with equal intervals between contractions, because the absence of oxygen carried in the blood, even for more than 30 seconds, can already affect the functioning of cells, and first of all, brain cells. The occurrence of oxygen starvation (hypoxia) of the brain is especially important for conditions such as heart block.

Blockades of the 2nd and 3rd degrees, complete intraventricular blocks, three-bundle block (of both the right and both branches of the left leg of His) almost always occur with organic damage to the heart tissue. Diseases that cause inflammatory or scarring processes in the myocardium include:

Prevention is competent drug treatment of the underlying disease, timely determination of indications for implantation of a pacemaker.

Forecast

The prognosis for first degree blockades in the absence of organic heart damage is favorable.
For complete blockades, the prognosis is determined by the nature of the underlying disease, the degree of cardiac dysfunction and the stage of chronic heart failure. The frequency and number of MES attacks are not predictors of mortality, that is, they do not affect the prognosis - in some patients, attacks can occur frequently, while in others, a single attack in a lifetime can be fatal.

The prognosis for patients in the acute period of myocardial infarction, complicated by the development of complete left or right His bundle block, is extremely unfavorable.

General practitioner Sazykina O.Yu.

anonymously

Good afternoon Please tell me. I am very concerned about the condition of my heart. 6 years ago I was admitted to the hospital with an attack of strong heart palpitations, examined, except for prolapse mitral valve They didn’t find anything, they diagnosed “self-tophoric autonomic dysfunction with the axioms of supraventricular tachycardia.” Further, the condition was not very good, frequent attacks and fear, I went to many doctors, they assured me that there were no problems with my heart, I should go to a psychotherapist. But first they prescribed anaprilin, then concor to relieve the attacks. I drank them for a very short time, later I switched to obzidan, it helped better. Gradually, I partially coped with my fears and attacks and drank a quarter of obsidan only if something arose, rarely, rather to calm myself down. Then, for many months, I didn’t drink anything at all, I coped with it, and if attacks occurred, I endured them and they passed. At this stage I am pregnant, 20 weeks. Due to pregnancy, I was sent for an ECG, I have a terrible fear of these studies, since I have developed a phobia, and accordingly, when I enter the office, my pulse jumps terribly. Having seen 120 on the ecg and having learned about prolapse, I was sent for a consultation to a maternity hospital for heart patients. Why was it necessary to collect all the research again? I did an echo, the result: left atrium: PZR (Plax) 32 mm (N up to 40 mm), volume (A4ChV) 38 ml (N up to 60 ml); left ventricle: not dilated Cdr 45 mm (N up to 56 mm) cdr 27 mm (N up to 38 mm) cdr 93 ml (N up to 155) cdr 28 ml (N up to 75 ml); contractility of the left ventricular myocardium: no zones of asynergy were detected. Ejection fraction 70% (N >55%); LV diastolic function: not impaired. Right atrium: not dilated, volume (A4ChV) 32 ml (N up to 60 ml). Right ventricle: not dilated. Interatrial septum: intact. Interventricular septum: correct movement TMZH 9 mm (N 6-11 mm), LVTS 7 mm (N 6-11 mm); mitral valve: the leaflets are thin, mobile, movement in antiphase. The anterior leaflet of the mitral valve will expand into the vulgarity of the left atrium to 4.8 mm. Mitral regurgitation: 1st -2nd degree. Aortic valve: The valves are not sealed. Aortic root diameter 31 mm ((N 21-36 mm) amplitude of aortic valve opening 19 mm (N 15-26 mm) regurgitation: not determined. PSV 107 cm/sec (85-170 cm/sec) PeakGD 4.3 mm hg . Tricuspid valve: leaflets are not sealed, movement is in antiphase. Tricuspid regurgitation grade 1. Pulmonary artery: not dilated. Signs pulmonary hypertension No. Pericardial and pleural effusion: not visualized. Echo conclusion: the heart chambers are not dilated, the global contractility of the left ventricle myocardium is satisfactory, no zones of local contractility disturbances have been identified, the indicators of systolic and diastolic functions of the left ventricle are normal. Mitral valve prolapse grade 1. Mitral regurgitation of 1-2 degrees. Tricuspid rugugitation stage 1. Holter: the main rhythm is sinus tachycardia, the average heart rate per day is 102 per minute. Transient 1st degree AV block with a max PQ of 0.24" during daytime rest. Maximum heart rate 171 per minute during exercise. Minimum heart rate 69 during night rest. 1 single supraventricular extrasystole was recorded. 2 single polymorphic polytopic early ventricular extrasystoles were registered. Analysis of temporary ( Time Domain) analysis of heart rate variability: sdnn - 82, mc- below normal: sdnn1-31 - below normal: rmssd - 12 - below normal: pnn50% - 0 - below normal Circadian index 1.20 (normal 1.24-1.44) , which indicates a normal circadian heart rate profile. Maximum QT interval 0.40. No diagnostically significant shift of the st segment was registered. Pauses (loss of QRS) for more than 2 seconds. No. Doctor, what can you say based on what you read? Nobody really listened to me in the cardio-maternity hospital , in 3 minutes they looked at these papers, didn’t like the blockade and wrote to give birth to them. I’m very scared, because I only made myself believe that I don’t have a heart pathology. But then why a special maternity hospital? I also read that such a blockade is caused by VSD, passes and is purely functional. Is it so? Are doctors simply playing it safe? Just based on what I read, I didn’t have any causes or illnesses before the blockade developed. How dangerous is all this during childbirth? Thank you very much in advance.

I will say that you have a severe neurotic disorder. I can’t imagine how to treat it (you can’t get away with drugs here), but you will drive everyone crazy - that’s for sure. I don’t see any special cardiac problems, except for the mention of “paroxysms of supraventricular tachycardia.” Transient 1st degree AV block did not impress me, this happens very often. With this you can give birth even in a barn. A good way out of the situation now would be verbal psychotherapy. The only problem is that this is not a very cheap pleasure.

anonymously

Thank you very much. Very calming. I know about nervous disorders and psychotherapy, and I’m trying to work on it. It’s just very difficult to concentrate on treating neurosis if you are made to doubt your physical health. The cardiologist at the maternity hospital was just confused by the transient 1st degree autoblockade and she said that childbirth in the maternity hospital was indicated for me with a cardiotype. For me, this sounded like a death sentence after a 6-year struggle with neurosis and at least some confidence that such conditions were really generated by my sick imagination and they were not dangerous. That is, if I understand correctly, this blockage came out, perhaps just once, on my halter and the doctor did not look into it and take responsibility since I was pregnant? It is very important for me to understand that this is not a real heart problem that has arisen that needs to be solved. As a layman in the field of medicine, I may not correctly interpret the words of doctors. After all, not everyone will delve into the peculiarities of my psyche and construct sentences in such a way that I would not consider it a serious illness. Perhaps if I had understood this, I would not have been so scared because of the increased pulse and would not have rushed to the hospital with such consequences for the nervous system. Sorry it's so confusing. Thank you again.

anonymously

What kind of certificate for pregnant women? In principle, I’m not working right now, if you meant sick leave. I was just very stressed by the conclusion of the maternity hospital. I was thinking of entering into a contract with a maternity hospital so that I could go with my husband, but that cardiac maternity hospital might close for cleaning just in time for my birth, and the second one, which will replace it, will close next. That is, I have either or for free, and neither one nor the other will enter into contact with me. And in others they simply don’t take you with such an entry in the exchange. That is, the only option is to go by ambulance and so be it. I was prescribed a repeat holter around 30 weeks. If this doesn’t come up there, they might still think again and set up a regular maternity hospital, or at least a maternity hospital at the hospital, and not just one, what do you think?

anonymously

Good afternoon I have already contacted you regarding transient 1st degree AV block. She told her story in detail and laid out all the studies: ECHO and holter at about 20 weeks of pregnancy. Now I’m almost 30 weeks pregnant and I had the Holter done again for a second consultation at the maternity hospital. Please comment. Very worried. Conclusion: During daily ECG monitoring, the main recorded rhythm was sinus, with a max heart rate of 145 per minute and a min heart rate of 92 per minute. The circadian index is reduced and amounts to 1.08. During the study period, a single ventricular extrasystole was recorded. No supraventricular rhythm disturbances were detected. No paroxysmal rhythm disturbances were registered. Fluctuations in AV conduction were 0.16-0.19 sec. No diagnostically significant pauses were identified. According to the indicators of heart rate variability, a constant and pronounced predominance of sympathetic influences on the heart rhythm is noted throughout the entire observation period (SDNN 48 ms). The dynamics of the ST segment against the background of tachycardial syndrome has a natural character of an oblique ascending type. No reliable ischemic dynamics of the ST segment were recorded. Please see the previous Holter and Echo to compare. I couldn’t figure out whether there was an AV block on this holter, but the reduced circadian index really scared me. I read horror stories about this on the Internet. Tell me, how serious is this? Or is this a one-time indicator that doesn’t mean anything. I’m worried that I had a holter done on the day when I generally felt very bad: I had an upset stomach, my intestines were full, nausea at night and very bad dream. The night before the installation of the device, I was also emotionally overloaded and slept little. Could this affect these circadian index values? I’m already afraid to go to the maternity hospital, what they will tell me there. Sorry for the confusion. Thank you in advance.