ISSN 2398-2969      

Heart: second degree atrioventricular block

icanis

Synonym(s): Partial AV block


Introduction

  • Cause: slowed conduction throughout the atrioventricular node:
    • Can be due to excessive vagal tone, metabolic disorders, cardiomyopathies or idiopathic.
    • Can be found in clinically normal dogs - may be benign in some cases.
  • Signs: may be incidental finding; if advanced, there can be weakness or syncope.
  • Diagnosis: signs, missed beats may be heard at auscultation, electrocardiography.
  • Treatment: may respond temporarily to atropine if vagally mediated; may not require therapy; permanent, advanced and symptomatic block should be treated with a cardiac pacemaker.
  • Prognosis: very variable, from good to sudden death through asystole.

Pathogenesis

Etiology

  • Congenital: reported in pugs Pug → bundle of His stenosis.
  • Iatrogenic: cardiac glycosides (digitalis Digoxin ); alpha-2 adrenoceptor stimulant sedatives (xylazine Xylazine ).
  • Class IA anti-arrhythmic agents, eg quinidine Quinidine , procainamide Procainamide ; calcium antagonists Diltiazem , eg verapamil Verapamil.
  • Functional: Mobitz Type I may occur with increased vagal tone, especially in brachycephalic dogs, in association with sinus arrhythmia. Occasionally with CNS diseases, eg head trauma Brain: trauma , brain tumor Brain: neoplasia , encephalitis Encephalitis.
  • Myocardial disease: Mobitz Type II may occur with myocardial diseases such as myocarditis Heart: myocarditis , infarction or with infiltrative disorders such as neoplasia or fibrosis.
  • Degenerative disease: degeneration of the AV node and/or bundles of His may occur with age.
  • Metabolic disease: occasionally associated with hyperkalemia.

Predisposing factors

General
  • Brachycephalic breeds can show Mobitz Type I block as a variant of sinus arrhythmia.

Specific

  • Respiratory diseases, eg airway obstruction, and CNS disease, eg brain tumor, can cause AV block, particularly Mobitz Type I.

Pathophysiology

  • Mobitz Type I: (Wenckebach: variable P-Q interval) is usually associated with a high vagal tone, which delays conduction through the AV node. This can be caused iatrogenically or be functional.
  • Often reasonably benign if only occasional beat missed, and it may disappear at elevated heart rates.
  • Mobitz Type II: (fixed P-Q interval) more often associated with more severe disease of the conduction pathways, disturbing the transmission of the impulse from atria to ventricles. Can be due to infiltrative or degenerative myocardial diseases.
  • May progress to more advanced AV blocks such as third degree (complete) AV block. Multiple missed beats may be found and ventricular escape complexes may be recorded.

Timecourse

  • Mobitz Type I disease may never progress to a more serious arrhythmia.
  • Mobitz Type II disease may or may not be symptomatic, but may lead to collapse or sudden death, notably through the development of third degree (complete) AV block Heart: 3rd degree atrioventricular block.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

Other sources of information

  • Lunney J & Ettinger S J (1995)Cardiac arrhythmias.In:Textbook of Veterinary Internal Medicine4th ed. Eds S J Ettinger & E C Feldman. Philadelphia: W B Saunders & Co.
  • Smith F W K, Tilley L P & Miller M S (1994)Electrocardiography.In:Saunders Manual of Small Animal PracticeEds S J Birchard & R G Scherding. Philadelphia: W B Saunders & Co.
  • Tilley L P (1992)Essentials of Canine and Feline Electrocardiography.3rd edn. Philadelphia: Lea and Febiger.
  • Sisson D D (1989)Bradyarrhythmias and cardiac pacing.In:Current Veterinary Therapy X.Ed R W Kirk. Philadelphia: W B Saunders & Co.

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