Aetiology of Complete Heart-block

Zoob, M; Smith, K

doi:10.1136/bmj.2.5366.1149

Cited by 117 publications

(60 citation statements)

References 8 publications

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“…Chronic rheumatic heart disease in association with a complete A-V block which responded to "steroid" therapy is reported in the present series (Case 29), and has been previously recorded by Litchfield et al (1958). In addition, Zoob and Shirley Smith (1963) have demonstrated scattered foci of myocardial fibrosis, occasionally associated with lymphocytic infiltration of the myocardium, in cases of complete heart block without coronary artery disease. If, indeed, some form of chronic "inflammatory" reaction was present in complete heart block, it would be reasonable to accept improvement in A-V conduction with corticosteroids and corticotrophin, without having to postulate a "facilitating" effect on nodal activity (Lown et al, 1955).…”

Section: Discussionsupporting

confidence: 72%

“…However, since spontaneous restoration of sinus rhythm is common and sometimes equally rapid under these circumstances, the true effectiveness of corticosteroids is difficult to assess (Penton, Miller, and Levine, 1956;Gilchrist, 1958;Zoob and Shirley Smith, 1963 resolution of the A-V block; and (ii) the likelihood that some patients will still require "pacing" for a short time before sinus rhythm returns (Friedberg et at., 1960). Sustained resolution of long-standing A-V block in a substantial number of patients in Group IT, though very satisfactory, contrasts sharply with the poor response observed by others when managing this type of clinical problem (Caramelli and Tellini, 1960;Dall and Buchanan, 1962;Dall, 1964).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Corticotrophin and corticosteroids in the management of acute and chronic heart block.

Aber¹,

Jones²

1965

Heart

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Clinical studies and individual case reports indicate that corticotrophin and corticosteroids frequently help to restore sinus rhythm in acute complete A-V heart block associated with recent myocardial infarction (Prinzmetal and Kennamer, 1954;Phelps and Lindsay, 1957;Aber and Wyn Jones, 1960;Caramelli and Tellini, 1960;Friedberg et al., 1960;Dall and Buchanan, 1962; Dalil, 1964). However, the true value of this form of treatment in chronic A-V block is less certain. Tung, Lu, and Fu (1957) and Litchfield, Manley, and Polak (1958) each reported two patients with long-standing block who reverted to sinus rhythm under corticotrophin therapy, and Pay and Waverley (1961) restored sinus rhythm in 5 out of 6 patients with chronic heart block, using oral corticosteroids. On the other hand, Caramelli and Tellini (1960) failed to improve A-V conduction in 10 patients, and in Dall's series (Dall, 1964) only 2 of the 14 patients with long-standing block regained sinus rhythm while receiving "steroid" therapy.Our experience of corticotrophin and corticosteroids in the treatment of heart block has been less pessimistic. Restoration of sinus rhythm or improved A-V conduction has not only been achieved in most patients with acute heart block, but also in an appreciable number with heart block of considerable duration. SUBJECTS AND METHODSBetween 1958 and 1964 we studied the effects of corticotrophin (ACTH) and corticosteroids on 36 patients with complete A-V block. These patients form 2 groups.Group I: 10 patients (6 men and 4 women) with acute heart block (less than 48 hours' duration) following recent myocardial infarction. The mean age was 60 years (range 43-80 years) and the mean duration of heart block before the start of "steroid" therapy was 16fi5 hours (range 4-48 hours) (Tables I and III). Group II: 26 patients (8 men and 18 women) with chronic heart block (longer than 1 month's duration). Of these, 11 had undoubted coronary artery disease. In the remaining 15 reliable evidence of coronary artery disease was lacking. The mean age was 61 years (range 34-77 years) and the mean duration of heart block in this group was assessed at 8 months (range 5 weeks to 30 months) (Tables II and III). In several patients accurate assessment of the duration of block was not possible; therefore some of the values recorded in Table II may have been underestimated. Selection and Management ofPatients. Corticotrophin or corticosteroids were given to all patients with acute heart block in association with recent myocardial infarction (Group I). Patients with chronic heart block (Group II) were selected for "steroid" therapy if they were experiencing either incapacitating StokesAdams syncope or were in either right or left heart failure and had failed to respond to more conventional treatment.The following criteria determined the initial management of these two groups of patients (Tables I and II). 916

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Corticotrophin and corticosteroids in the management of acute and chronic heart block.

Aber¹,

Jones²

1965

Heart

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“…4 The causes for the acquired AV conduction blocks can be due to fibrosis of the conduction system, ischemic heart disease, the use of certain negative chronotropic and dromotropic drugs, increased vagal tone, valvular heart diseases, cardiomyopathies, congenital disorders like transposition of the great vessels, electrolyte disturbances, autoimmune diseases, systemic diseases, such as Lyme disease. 5,6 Our patient probably had a block below the level of AV node. Pregnancy-induced hypertension complicated her health status.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic Management of a Parturient with Congenital Complete Heart Block posted for Emergency Lower Segment Cesarean Section

Karthik¹,

Mamatha²,

Sowmya³

et al. 2015

The Journal of Medical Sciences

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Pregnancy complicated with complete heart block is rare and usually required termination of pregnancy in the past. Improvement in medical technology in the form of cardiac pacing has allowed taking these women to term. Overall, maternal and fetal outcome is not affected in asymptomatic cases. We report here an unbooked, pregnant patient presented at 38+ weeks with complete heart block and pregnancy-induced hypertension for emergency lower segment cesarean section (LSCS). Emergency LSCS was performed under general anesthesia. Maternal and fetal outcome was good.

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“…Fibrosis and sclerosis of the conduction system accounts for about onehalf of cases of AV block and may be induced by several different conditions which often cannot be clinically distinguished. 16 However, the prevalence/incidence of complete degenerative AV block in young or middle-aged individuals is unknown. Bilateral bundle branch scleroatrophy and degeneration (particularly of the middle and distal portions) and upper interventricular septum crest fibrosis are typical histopathological findings of the Lenegre disease, 17 an idiopathic, fibrotic, degenerative disease restricted to the His-Purkinje system and not associated with inflammatory or ischemic involvement of adjacent myocardium.…”

Section: Degenerative Diseasesmentioning

confidence: 99%

Erratum

2012

Pacing Clinical Electrophis

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Complete atrioventricular block is a relatively uncommon arrhythmia that is nonetheless increasingly (PACE 2012; 35:1395-1405 complete atrioventricular block, atrioventricular block etiology, cardiac conduction IntroductionComplete heart block, also referred to as thirddegree heart block or third-degree atrioventricular (AV) block, is a disorder of the cardiac conduction system where there is complete dissociation of the atrial and ventricular activity due to the absence of conduction through the atrioventricular node (AVN) or His-Purkinje system. Although Mobitz I second-degree AV block is observed in 1-2% of healthy young people, especially during sleep, the prevalence of third-degree AV block is only 0.02% in the United States and 0.04% worldwide.1,2 Its incidence increases with advancing age (highest in people older than 70 years), despite an early peak in infancy and early childhood due to congenital

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Aetiology of Complete Heart-block

Cited by 117 publications

References 8 publications

Corticotrophin and corticosteroids in the management of acute and chronic heart block.

Corticotrophin and corticosteroids in the management of acute and chronic heart block.

Anesthetic Management of a Parturient with Congenital Complete Heart Block posted for Emergency Lower Segment Cesarean Section

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