Complete Heart Block In Pregnancy : A Case Report

Background: Complete heart block occurs due to various pathological conditions that cause an infiltration, fibrosis, or lose the connection from a part of the cardiac conduction system. Complete heart block in pregnancy is often caused by congenital anomalies. Around 30% cases, complete heart block remain asymptomatic and not detected until adulthood and may present in pregnancy state and puerperium. When the reversible cause of the AV Block cannot be found, the permanent pacemaker or temporary pacemaker may be indicated when the patients show the symptoms. Case Illusration: A-21 year old female, G2P0A1 preterm pregnancy (27-28 weeks) with bradycardia. From electrocardiograph examination revealed Total AV Block with junctional escape rhytym. Transthoracic echocardiogram shows massive tricuspid regurgitation, early phase of peripartum cardiomyopathy and ejection fraction 36-40%. Caesarean section was peformed due to PPROM. A male baby was born with birth weight of 1100 grams, 32 centimeters of body length and APGAR score of 7/9. The baby was died in NICU on day care 4th, with suspected respiratory problem. Conclusion: Complete heart block in pregnancy is a rare condition. This condition could remain asymptomatic and not detected until pregnancy. Multidisciplinary approach, close monitoring of the symptoms and cardiac functions are needed for patients with CHB.

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Congenital complete heart block in pregnancy

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2018-0042 ◽

2018 ◽

Vol 35 (2) ◽

Author(s):

Nurul Iftida Basri ◽

Shuhaila Ahmad

Keyword(s):

Postpartum Period ◽

Heart Block ◽

Multidisciplinary Approach ◽

Complete Heart Block ◽

Breech Presentation ◽

Permanent Pacemaker ◽

External Cephalic Version ◽

Congenital Complete Heart Block ◽

Temporary Pacemaker ◽

In Pregnancy

Abstract Complete heart block (CHB) is infrequently encountered during pregnancy. Its management requires a multidisciplinary approach involving the obstetrician, cardiologist, anesthetist and neonatologist. It varies from conservative, temporary or permanent pacemaker (PPM) insertion (either during the antenatal, intrapartum or postpartum period). We present the case of a 30-year-old, gravida 2 para 1 at the 36-week period of amenorrhea (POA) with congenital CHB. She was asymptomatic throughout her pregnancy despite having a pulse rate between 40 and 50 beats per minute. She delivered a healthy boy via cesarean section due to breech presentation after a failed external cephalic version. A temporary pacemaker was inserted prior to delivery. However, she required permanent insertion of pacemaker during the postpartum period.

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Complete heart block in Acute Rheumatic fever

Nepalese Heart Journal ◽

10.3126/njh.v9i1.8351 ◽

2013 ◽

Vol 9 (1) ◽

pp. 56-58

Author(s):

CM Poudel ◽

RM Gajurel ◽

M Barkoti ◽

SM Acharya ◽

OM Anil

Keyword(s):

Rheumatic Fever ◽

Heart Block ◽

Acute Rheumatic Fever ◽

Complete Heart Block ◽

Cardiac Conduction ◽

Conduction Disturbances ◽

Ventricular Premature Complexes ◽

Bundle Branch Blocks ◽

Temporary Pacemaker ◽

Electrocardiographic Changes

Rheumatic fever can cause a variety of cardiac conduction disturbances. First-degree heart block is a common electrocardiographic manifestation of acute rheumatic fever and is included in Jones’ diagnostic criteria. Other electrocardiographic changes such as sinus tachycardia, bundle branch blocks, nonspecific ST-T wave changes, atrial and ventricular premature complexes have been reported with variable frequency. However, complete heart block is an exceptionally rare manifestation of acute rheumatic fever. We report a 15 years female who developed Complete heart Block during an episode of acute rheumatic carditis. The patient was successfully treated with conventional treatment and Temporary Pacemaker. DOI: http://dx.doi.org/10.3126/njh.v9i1.8351 Nepalese Heart Journal Vol.9(1) 2012 pp.56-58

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Expert’s Opinion–Challenging ECG

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0040-1722766 ◽

2020 ◽

Vol 5 (04) ◽

pp. 368-372

Author(s):

Seema Kale

Keyword(s):

Myocardial Ischaemia ◽

Heart Block ◽

Complete Heart Block ◽

Conduction System ◽

Av Block ◽

Av Node ◽

Purkinje System ◽

Expert’S Opinion

AbstractVarying kinds of AV blocks can occur in the setting of myocardial ischaemia or due to degeneration of conduction system. Wenckebach AV block can present with typical Wenckebach periodicity or atypical periodicity. A variant of atypical Wenckebach periodicity may present like Mobitz II AV block. This is called Pseudo Mobitz II AV block. As we are aware that Mobitz II AV block is more dangerous and can suddenly convert into complete heart block, it is essential that we should try to differentiate between Mobitz and Pseudo Mobitz II blocks. Infact atypical Wenckebach cycles are quite common at both AV node and his Purkinje system.

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Complete Heart Block after open Heart Surgery in Children with Congenital Cardiac Diseases Feasibility of more waiting time before PPM administration

Clinical Cardiology and Cardiovascular Interventions ◽

10.31579/2641-0419/173 ◽

2021 ◽

Vol 4 (11) ◽

pp. 01-06

Author(s):

Akbar Molaei

Keyword(s):

Heart Block ◽

Congenital Heart ◽

Heart Surgery ◽

Complete Heart Block ◽

Heart Defects ◽

Open Heart Surgery ◽

Cardiac Conduction ◽

Cardiac Diseases ◽

Open Heart ◽

Cardiac Disorders

Introduction: Congenital cardiac disorders are the most prevalent congenital disorders which require interventional or surgical treatments. The most common causes of complete heart block (CHB) are degeneration of cardiac conduction system, acute myocardial infarction and congenital cardiac disorders. CHB after congenital heart surgery is of paramount importance which causes post-operation death and heart failure. Application of a pacemaker is a standard treatment for CHB. The purpose of this paper is to study the frequency of early postoperative CHB in patients with congenital cardiac diseases and also the need for temporary (TPM) and permanent (PPM) pacemakers. Materials and methods: This descriptive-analytical and cross-sectional study was conducted on children with congenital heart defects who had undergone open-heart surgery in Tabriz’s Shahid Madani Hospital from 2011 to 2016. Patients with early postoperative CHB were included in the study. Those who had improved on their own and those who needed TPM and PPM were identified and at the end, the frequency of CHB and the need for TPM and PPM were assessed. Results: Of the 2100 operated patients, 109 patients developed early postoperative heart block. The frequency of early CHB after open heart surgery was 5.19%. Of the 109 patients, 69 patients (63.3%) with early postoperative CHB needed TPM, 9 patients needed PPM and 22 patients improved without pacemaker. Conclusion: The prevalence of early CHB in patients operated for congenital cardiac diseases was 5.19%. The need for TPM was high and most of the patients had improved cardiac rhythm with no need for PPM or TPM.

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Case Report: Complete heart block as a manifestation of cardiac metastasis of oral cancer

F1000Research ◽

10.12688/f1000research.26438.2 ◽

2020 ◽

Vol 9 ◽

pp. 1243

Author(s):

Andrianto Andrianto ◽

Eka Prasetya Budi Mulia ◽

Denny Suwanto ◽

Dita Aulia Rachmi ◽

Mohammad Yogiarto

Keyword(s):

Pericardial Effusion ◽

Heart Block ◽

Complete Heart Block ◽

Tongue Cancer ◽

Pacemaker Implantation ◽

Metastatic Tumor ◽

Variable Number ◽

Permanent Pacemaker ◽

Cardiac Metastasis ◽

Temporary Pacemaker

Metastatic tumors of the heart presenting with complete heart block (CHB) is an extremely uncommon case. There are no available guidelines in managing CHB in terminal cancer. Permanent pacemaker implantation in such cases is a challenge in terms of clinical utility and palliative care. We report a case of a 24-year-old man suffering from tongue cancer presenting with CHB. An intracardiac mass and moderate pericardial effusion were present, presumed as the metastatic tumor of tongue cancer. We implanted a temporary pacemaker for his symptomatic heart block and cardiogenic shock, and pericardiocentesis for his massive pericardial effusion. We decided that a permanent pacemaker would not be implanted based on the low survival rate and significant comorbidities. Multiple studies report a variable number of cardiac metastasis incidence ranging from 2.3% to 18.3%. It is rare for such malignancies to present with CHB. The decision to implant a permanent pacemaker is highly specific based on the risks and benefits of each patient. It needs to be tailored to the patient’s functional status, comorbid diseases, prognosis, and response to conservative management.

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CONGENITAL HEART BLOCK DUE TO A LESION IN THE CONDUCTION SYSTEM

PEDIATRICS ◽

10.1542/peds.45.4.640 ◽

1970 ◽

Vol 45 (4) ◽

pp. 640-650

Author(s):

Cirilo Sotelo-Avila ◽

Harvey S. Rosenberg ◽

Dan G. McNamara

Keyword(s):

Heart Block ◽

Congenital Heart ◽

Complete Heart Block ◽

Fibrous Tissue ◽

Postmortem Examination ◽

Conduction System ◽

Cardiac Conduction ◽

Fibrous Body ◽

Congenital Complete Heart Block ◽

Bundle Of His

The cardiac conduction system of an infant with congenital complete heart block was studied at postmortem examination by subserial sections of the interatrial and interventricular septa. A localized area of necrosis in the central fibrous body interrupted the penetrating portion of the bundle of His. The cardiac structure was intact, with no abnormality other than the lesions in the fibrous tissue. The lesion is interpreted as the result of an acquired inflammation late in intrauterine life, with damage localized to the cardiac central fibrous body.

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Complete Heart Block in Pregnancy: A Report of Emergency Caesarean Section in a Parturient without Pacemaker

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2016/20173.8606 ◽

2016 ◽

Author(s):

VANDANA MOHAPATRA

Keyword(s):

Caesarean Section ◽

Heart Block ◽

Complete Heart Block ◽

Emergency Caesarean Section ◽

Emergency Caesarean ◽

In Pregnancy

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Transiently elevated estimated pulmonary pressures in a patient with complete heart block undergoing permanent pacing: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa072 ◽

2020 ◽

Vol 4 (3) ◽

pp. 1-4

Author(s):

Robert Harvey ◽

Adrian Chong ◽

John Hill ◽

Dariusz Korczyk

Keyword(s):

Right Ventricular ◽

Heart Block ◽

Complete Heart Block ◽

Systolic Pressure ◽

Left Ventricular ◽

Cardiac Conduction ◽

Clinical Report ◽

Presenting Symptoms ◽

Permanent Pacing ◽

Acute Elevation

Abstract Background Complete heart block (CHB) is a frequent cause for acute admission in older patients with significant cardiac conduction disease. Common presenting symptoms are syncope and dyspnoea. Some patients may exhibit clinical and radiological signs of left ventricular (LV) decompensation, despite preserved LV ejection fraction on transthoracic echocardiography (TTE) and absent pre-existing LV dysfunction. Case summary In this clinical report, we present a case of CHB associated with transient but severe elevation in pulmonary artery systolic pressure, measured as the equivalent right ventricular systolic pressure (RVSP = 99 mmHg) by TTE in the absence of right ventricular outflow tract obstruction, that subsequently ‘normalized’ after implantation of a permanent pacemaker. After searching our echocardiogram database, we did find other cases with similar findings. Discussion There is limited literature describing transient acute elevation in estimated pulmonary pressures in the setting of new CHB that is subsequently reversed by permanent pacing. The true prevalence and mechanism of transient estimated pulmonary pressure as a result of CHB remains unknown. Based on our limited assessment, we postulate that the acute elevation in estimated pulmonary pressures is predominantly related to a compensatory augmentation of RV stroke volume and is caused by the underlying bradycardia and need to maintain forward cardiac output. This phenomenon may require further investigation and validation in future studies.

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