Heart Block - Symptoms, Causes, Images and Treatment

Imagine the heart as a conductor, sending electrical signals to keep the beats in rhythm. Sometimes, these signals face a barrier, causing heart block. It is commonly associated with heart diseases, especially arrhythmia (abnormal heartbeat).

With cardiovascular diseases on the rise, the prevalence of complete heart block cases in India is concerning. Due to a lack of noticeable symptoms, many heart block cases go undiagnosed. The following guide discusses everything related to heart block. Keep reading to learn about its types, causes, treatment and more.

A heart block is a medical condition characterised by a disruption or delay in the electrical signals that regulate the heartbeat. These electrical signals control the rhythmic contractions of the heart muscle. This helps to maintain a steady and efficient heartbeat. 

When a heart block occurs, it can disturb this coordination. This results in an irregular or slow heart rate. It is also referred to as an atrioventricular (AV) block. A typical resting heart rate for adults ranges from 60 to 100 beats per minute (bpm). During a heart block, it can drop down to as low as 40 bpm.

Heart block is frequently observed in patients suffering from atrial fibrillation (the upper chamber of the heart beats irregularly) and atrial flutter (the upper chamber of the heart beats regularly but at a faster rate). Both are types of arrhythmia. 

Based on the Global Burden of Disease (GBD) report of 2019, the average prevalence of these two conditions is approximately 772 individuals per 100,000 individuals in India. This report was published by the Institute for Health Metrics and Evaluation (IHME). Heart diseases associated with a blocked artery in the heart can also be responsible for a heart block. 

Heart block comes in different types, each with its characteristics and implications. These types are categorised based on the degree of disruption in the electrical signals that control the heartbeat:

1. First-degree Heart Block: In this type, there is a delay in the electrical signals as they pass from the atria (upper chamber of the heart) to the ventricles (lower chamber of the heart). It's typically considered a mild form of heart block and often doesn't cause noticeable symptoms.

2. Second-degree Heart Block: This type is further divided into two subtypes:

1. Type 1 (Mobitz I or Wenckebach): It involves gradually lengthening the delay between beats until a beat is missed. This cycle then repeats.

2. Type 2 (Mobitz II): Here, occasional beats are dropped without any preceding lengthening of the delay. Type 2 is more severe and often requires treatment.

3. Third-degree heart Block(Complete Heart Block): This is the most severe type of heart block. There is a complete blockage of electrical signals between the atria and ventricles. As a result, the ventricles beat independently of the atria. This leads to a slower and irregular heart rate. 

Heart block can have a range of symptoms. Based on the types of heart block, the severity of these symptoms can vary. Here are the common symptoms associated with different degrees of heart block:

First-degree Heart Block Symptoms

1. Typically, first-degree heart block does not exhibit noticeable symptoms.

2. Some individuals may encounter slight fatigue or mild dizziness.

3. These signs are generally subtle and may not be directly caused by heart block.

4. First-degree heart block is frequently discovered incidentally during routine medical check-ups or electrocardiogram (ECG) assessments.

Second-degree Heart Block Symptoms

Type 1 Symptoms

1. Patients may undergo gradual and intermittent changes in heart rhythm.

2. Symptoms can include decreased heart rate, palpitations, or the sensation of skipped heartbeats.

3. A feeling of lightheadedness may happen.

Type 2 Symptoms

1. Often presents with more pronounced and unpredictable symptoms.

2. Patients might encounter abrupt instances of fainting (syncope) as a result of extended pauses in heartbeats.

3. Dizziness, weakness, and breathlessness can occur, especially during physical exertion.

Third-degree Heart Block Symptoms

1. Patients commonly experience a very slow, irregular and unreliable heart rate.

2. Severe fatigue, dizziness and frequent episodes of fainting. This happens due to insufficient blood flow and oxygen delivery to the body.

3. Nausea, shortness of breath, chest discomfort and disorientation are commonly observed.

Heart block can occur due to various factors that disrupt the normal transmission of electrical signals between the atria and ventricles of the heart. These factors can result in different degrees of heart block. Below are the causes of heart block:

1. Heart Disease: Heart conditions like coronary artery disease, myocardial infarction (heart attack), or cardiomyopathy can cause harm to the heart muscle.
   This harm can extend to the electrical pathways of the heart, disturbing the typical conduction of signals and resulting in heart block.
   

2. Ischemia: Reduced blood flow to the heart muscle, termed ischemia, can result in heart block. This occurs in areas of the heart with compromised blood supply.

3. Autoimmune Disorders: Autoimmunity refers to a condition where a person's immune system attacks its cells. It cannot be cured. Conditions such as lupus can generate antibodies that disrupt the electrical signals of the heart, ultimately causing heart block.
   

4. Congenital Factors: Some individuals are diagnosed with heart block at birth, a condition known as congenital heart block. It can be linked to maternal autoimmune disorders. In this case, antibodies from the mother affect the baby's heart during pregnancy.
   

5. Idiopathic Causes: In certain instances, the precise cause ofheart block may remain unknown (idiopathic). These cases require continuous monitoring to determine the underlying cause over time.

Heart Block Risk Factors

Heart block is associated with common risk factors. These can be classified into non-modifiable and modifiable risk factors:

Non-modifiable Risk Factors

These are risk factors that an individual cannot regulate, making them naturally more prone to heart block. These include:

2. Gender: Studies show a higher predisposition of heart block in men, according to some studies. The reason for this gender variance is not fully elucidated, but potential hormonal or genetic influences could be factors.

3. Age: Advancing age elevates the susceptibility to second-degree and complete heart block. Over the years, fibrous tissue develops within the heart. This can block the pathways that electrical signals take, leading to slower conduction.

3. Family history: A familial heart block history or other heart rhythm disorders suggests a genetic inclination. Mutations in genes like TRPM4 and SCN5A are responsible for progressive familial heart block.

Modifiable Risk Factors

These are risk factors that a heart block patient can identify and reduce their influence to cause a heart block. These include

1. Medications: Certain drugs prescribed for various medical conditions can disrupt the electrical system of the heart. Medications like beta-blockers and antiarrhythmics have the potential to decelerate or block the transmission of electrical signals. This results in heart block as an adverse consequence.

2. Infections and Inflammation: Infections affecting the heart, such as myocarditis, can instigate inflammation and harm the heart muscle. The inflammatory response within the heart can interfere with the electrical pathways, escalating the risk of heart block.

3. Lifestyle Factors: Unhealthy lifestyle preferences like smoking, excessive alcohol consumption, and an inactive routine can increase heart disease risk. As a result, the chances of heart block also increase.

4. Obesity: It is correlated with a heightened risk of heart disease and high blood pressure. The excess weight strains the heart and interferes with its electrical conduction system, potentially leading to heart block.

5. Hypertension: Heart block can be caused by high blood pressure. It can adversely affect the electrical pathways of the heart.

6. Diabetes: Poorly managed diabetes can catalyse the progression of atherosclerosis (narrowing of blood vessels) and cardiovascular diseases. This can lead to an AV block.

Preventive measures for heart block involve addressing its risk factors and adopting a healthy and active lifestyle. Common practices to prevent heart block are:

1. Regular Health Check-ups: Consistent check-ups with a doctor are vital. It is particularly important for those with heart disease or a family history of heart block.
   These check-ups aid in the early detection of heart block signs or other cardiac issues, enabling timely intervention.

2. Address Underlying Heart conditions: Effectively managing heart conditions like coronary artery disease or cardiomyopathy is important. This includes adhering to prescribed medications and following treatment plans. It can also involve managing the dosage of medicines.

3. Adopting heart-healthy habits: Quitting smoking, having little to no alcohol intake, and maintaining a well-balanced diet reduces heart block risk. A diet low in saturated fats, cholesterol, and sodium should be preferred.

4. Regular exercise routine: Engaging in routine physical activity (for example- brisk walking, jogging, etc.) is instrumental in managing weight and enhancing cardiovascular fitness. It contributes to overall heart health and diminishes the risk of heart block.

5. Blood pressure regulation: Individuals with hypertension should diligently monitor their blood pressure and follow prescribed medication routines. Monitoring sodium intake contributes to blood pressure regulation.

6. Diabetes Management: Keeping diabetes under control reduces the risk of heart disease and heart block.

7. Stress alleviation: Elevated stress levels can contribute to cardiac issues. Practising stress-reducing techniques such as meditation or yoga aids in stress management and improves heart health.

8. Avoid Overeating: Overeating can lead to weight gain, which can strain the heart. Maintain regular eating schedules to stabilise blood sugar levels and prevent overeating.

Diagnostic techniques for heart block encompass a range of medical assessments which aim at evaluating the electrical conduction system of the heart. These methods help identify the specific type and severity of the blockage. Common heart block diagnostic techniques include:

1. Clinical Evaluation

1. A cardiologist plays a pivotal role in diagnosing and managing heart block.

2. They evaluate the patient's medical history, symptoms, and the results of diagnostic tests to formulate an appropriate treatment strategy.

2. Blood Tests

1. Blood tests are conducted to investigate potential underlying factors contributing to heart block. This can include infections or autoimmune disorders.

2. They may also reveal electrolyte imbalances that might impact heart rhythm.

3. Electrocardiogram (ECG or EKG)

1. The foremost and most prevalent diagnostic tool for heart block remains the electrocardiogram (ECG or EKG).

2. This test records the electrical activity of the heart, providing insights into its rhythm. This helps in detecting any irregularities in electrical conduction.

3. Different types of heart block, such as first-degree, second-degree, or third-degree heart block, can be discerned through ECG readings.

4. Exercise stress test

1. It is conducted to assess the response of the heart to physical exertion.

2. During this test, patients exercise on a treadmill or stationary bike while being closely monitored via an ECG.

3. The objective is to reveal any exercise-induced heart block or other rhythm irregularities.

5. Holter Monitor

1. It is used for individuals who experience sporadic or suspected heart block not readily evident on a standard ECG.

2. The Holter monitor is a portable device that continuously records the electrical activity of the heart over a 24 to 48-hour period. This enables the detection of intermittent episodes of heart block.

6. Event Monitor

1. Similar to the Holter monitor, an event monitor is a portable device suited for extended monitoring periods.

2. It is usually worn for several weeks or even months, with patients instructed to activate it when they experience symptoms.

3. This approach aids in capturing infrequent heart block episodes.

7. Electrophysiology Study (EPS)

1. It is used in situations where the precise location and type of heart blockremain inconclusive through non-invasive assessments.

2. During an EPS, thin, flexible catheters are introduced through blood vessels and positioned within the heart.

3. These catheters measure the internal electrical signals of the heart. This helps in identifying the block's location and severity.

8. Tilt-table Test

1. This test is employed when fainting is associated with heart block symptoms.

2. Patients are positioned on a specialised table that tilts to simulate various body positions.

3. Monitoring of heart rate and rhythm changes helps determine if fainting episodes are linked to heart block.

9. Imaging Studies

1. In specific cases, imaging studies like echocardiography (heart ultrasound) or cardiac magnetic resonance imaging (MRI) may be utilised to assess the structure and function of the heart.

2. These assessments aid in identifying structural irregularities that could be contributing to heart block. Detailed heart block images are produced.

How to Prepare for the Doctor's Consultation?

Preparing for a doctor's consultation on heart blockinvolves several key steps. These include:

1. Collect a comprehensive medical history, including prior heart conditions, medications, and symptoms. Ensure it includes specific details like the frequency and duration of symptoms.

2. Create a list of questions and concerns to discuss with the doctor during the appointment. This helps ensure that important topics are covered. Some common questions that patients can ask the doctor:

1. What is my specific type of heart block, and what is its severity?

2. What might be the causes of heart block, and are there underlying conditions to consider?

3. What options for heart block treatment are available, and which is best suited to my case?

4. What lifestyle adjustments should I make to manage my heart block effectively?

5. What symptoms or warning signs should I watch for, and when should I seek immediate medical help?

6. Are there potential complications or risks associated with my heart blockthat I should be aware of?

7. What can I expect regarding long-term prognosis and my daily life with heart block?

8. Can you show me some heart block diagrams for better understanding?

3. Be ready to discuss lifestyle factors like diet, exercise habits, smoking and alcohol consumption. These details provide insights into overall heart health.

There are a large number of heart block treatment options available, ranging from non-surgical home remedies to invasive surgical options. These are listed below:

Non-surgical Treatment

This approach involves treating heart block without cutting through the body. These broadly include:

1. Home Remedies: These options can be incorporated by heart block patients into their daily lives:

1. Sugar-free pomegranate juice can reduce heart block risk by lowering blood pressure and bad cholesterol.

2. Green and black tea can help decrease plaque buildup in artery walls. This lowers the risk of heart diseases, including heart block.

2. Ayurvedic Treatment: Ancient medicine has been long used to treat heart problems, including heart block. However, these should not replace doctor-prescribed medications. These can include:

1. Herbs like Ashwagandha, Arjuna, and Guggulu are known for their potential cardiovascular benefits. These herbs help improve blood flow to the heart.

2. Virechana (therapeutic purgation) and Basti (enema) are specific Panchakarma (detoxification) therapies that may be considered for improving heart health. These techniques help lower blood pressure, which helps in preventing heart block.

3. Breathing practices like Anulom Vilom and Bhramari Pranayama are believed to be beneficial. These practices can improve heart rate.

Note that a doctor should approve Ayurvedic practices and should only be done under the supervision of a qualified Ayurvedic practitioner.

3. Homoeopathic Treatment: This treatment stimulates the body's natural healing abilities. It may be used as a complementary therapy for various health conditions, including heart block. Common treatments include:

1. Digitalis: It is commonly used in homoeopathy for heart-related conditions. It may help with heart block associated with slow or irregular heartbeats.

2. Hawthorn: This may be used to support cardiovascular function and improve circulation.

4. Medications: Heart block medications may be prescribed to manage symptoms, improve heart rate, or address underlying causes. The choice of medication depends on the type and severity of the heart block. Here are some medications used forheart block treatment:

1. Atropine: This is often administered in emergencies to treat bradycardia (slow heart rate). It works by blocking the action of the vagus nerve, which helps increase heart rate temporarily.

2. Beta-blockers: They may be prescribed to manage heart block associated with conditions like atrial fibrillation or atrial flutter. These medications slow down the heart rate and reduce the workload on the heart.

3. Antiarrhythmic Medications: These drugs may be used to regulate heart rhythm. They also help to manage irregular heartbeats associated with heart block.

Note that medicines for heart block treatment are prescribed in consultation with a cardiologist.

Surgical Treatment

Surgical procedures for heart block vary depending on the type and severity of the block. Common surgical procedures used in the management of heart block include:

1. Permanent Pacemaker: The most common surgical procedure for treating heart block is the implantation of a permanent pacemaker. It is a small device that is surgically placed under the skin, usually near the collarbone. It has leads (thin wires) that are threaded through veins into the heart. The pacemaker continuously monitors the electrical activity of the heart. When necessary, it sends electrical impulses to stimulate the heart to beat at a normal rate.

2. Catheter Ablation: It is a minimally invasive procedure used to treat certain types of heart block caused by abnormal electrical pathways or accessory pathways. It involves threading thin catheters through blood vessels to the heart. This is followed by using radiofrequency energy or freezing to destroy or modify the abnormal pathways.

3. Cardiac Surgery: In severe cases of heart block, especially when associated with other complex heart conditions, cardiac surgery may be required. This can include repairing damaged heart tissue or rerouting electrical pathways.

Treatment choice depends on the specific type and degree of heart block. It also depends on the individual's overall health and symptoms.

Cost of Treatment

The cost of heart block treatment can vary depending on the type of heart block to be treated. It also depends on the location of the hospital and the severity of the patient's condition. Given below is an approximate range of various heart block treatment options.

The prognosis and survival rate of heart block vary depending on several factors:

1. First-degree heart block is considered benign and may not significantly impact life expectancy. Those with this type of heart block often lead normal lives without the need for specific treatment.

2. Second-degree heart block prognosis depends on the type. Type I is usually benign and reversible. Type II is more concerning. With proper treatment, especially pacemaker implantation, individuals can have a favourable prognosis.

3. Complete heart block (third-degree) is the most severe form, requiring prompt pacemaker implantation. With a pacemaker, individuals typically have good prognoses. Without treatment, it can be life-threatening, even leading to heart failure or cardiac arrest.

4. Based on a study of Indian patients with complete heart block, the survival rate is only 32 % without pacemaker treatment within 5 years. With pacemaker implantation, the survival rates can be up to 90 % in 1 year and 74 % in 3 years.

The underlying cause also plays an important role. Reversible causes, like medication side effects, may have better prognoses once addressed. Heart diseases may have less favourable prognoses, especially if advanced or not effectively treated.

If heart block treatment is overlooked, it can lead to a series of risks and complications. These include:

1. Bradycardia-related Effects: When heart block remains untreated, it can result in sustained bradycardia (slow heart rate). 

2. Arrhythmic Events: Heart block can trigger diverse arrhythmias, encompassing ventricular arrhythmias, atrial fibrillation, or atrial flutter. 

3. Heart Failure: Particularly in the case of a complete heart block, the pumping efficiency of the heart diminishes, potentially leading to heart failure.

4. Fainting: Heart block can induce sudden heart rate drops, resulting in episodes of fainting. If these episodes occur during activities like driving or operating machinery, they can lead to injuries.

5. Elevated Stroke Risk: Specific types of arrhythmias linked with heart block, such as atrial fibrillation, can heighten the likelihood of blood clot formation within the heart chambers. If these clots travel to the brain, they can trigger a stroke.

6. Daily Life Affected: Neglected heart block significantly restricts an individual's ability to engage in physical activities. It also puts constraints on daily routines.

7. Sudden Cardiac Arrest: In severe instances or if underlying conditions are present, untreated heart block may culminate in sudden cardiac arrest. This condition can be life-threatening.

When to Consult a Doctor?

Take a doctor's appointment as soon as possible if the following heart block symptoms are regularly observed:

1. Lightheadedness or fainting 

2. Chest pain

3. Shortness of breath

4. Heart palpitations

A patient diagnosed with a heart block should follow a diet that not only reduces heart block risk but also other cardiac disorders. Listed below are some common dietary guidelines for a heart block patient:

1. Low-fat Diet

1. Limit saturated and trans fats found in fried foods, ghee, butter and processed snacks. Opt for healthier cooking oils like olive oil, mustard oil or coconut oil.

2. Include heart-healthy fats like nuts and seeds in moderation.

2. High-fibre Foods

1. Consume ample fruits, vegetables and whole grains like brown rice, whole wheat and oats.

2. Fibre helps lower cholesterol levels and promotes heart health.

3. Lean Protein Sources

1. Choose lean sources of protein like skinless poultry, fish, legumes and paneer.

2. Limit red meat consumption, especially processed meats.

4. Low-sodium Diet

1. Reduce salt intake to lower blood pressure. Avoid adding extra salt to meals.

2. Be cautious of high-sodium processed foods, canned soups and restaurant/fast food.

5. Limit Sugar and Sweets

Minimise sugary foods and beverages. Opt for natural sweeteners like honey or jaggery in moderation.

6. Use The right spices

Use spices like turmeric and ginger, which have anti-inflammatory properties that support heart health.

7. Include omega-3 fatty acids

1. Consume sources of omega-3 fatty acids like flaxseeds, walnuts and fatty fish.

2. Omega-3 fatty acids prevent heart disease risk and reduce inflammation.

8. Hydration

1. Stay well-hydrated with water, herbal teas, or unsweetened beverages.

2. Limit excessive caffeine and alcohol intake.

9. Balanced Meals

Aim for balanced meals that include a variety of food groups to ensure proper nutrition.

In a nutshell, effectively managing heart block necessitates a comprehensive strategy. This includes blending medical intervention with healthy lifestyle choices and dietary habits. Following prescribed medication and timely intervention like pacemaker implantation when advised are vital. Making necessary lifestyle adjustments such as regular exercise, quitting smoking and reducing alcohol intake further contributes to maintaining a healthy heart. 

Discover comprehensive cardiac care at HexaHealth! We offer invaluable insights on various disorders, including heart block, treatment options, and associated costs. Need expert guidance? We connect you with experienced doctors. Get in touch with HexaHealth today for valuable healthcare resources and consultations!

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