Heart block- Do you need a pacemaker?

Mr. Anderson, a 58-year-old schoolteacher, complains of dizziness. He has been experiencing fatigue and chest pain since. He has a history of hypertension and has been taking his medication regularly. His general health is otherwise good. He is worried that he has a heart block and needs a pacemaker.

What is Heart Block?

What is heart block

It is a problem in the electrical system of the heart. The heart has four chambers and four heart valves, which regulate the blood supply in the body normally. Typically, the electrical signal starts from the sinoatrial node (SA node) at the right atrium to the atrioventricular node (AV node). From the AV node, it goes to the Bundle of His, and ultimately, it extends into the right and left ventricles. Heart blocks occur when these electrical signals, which move from top to bottom, are disrupted or delayed.

There are three types of heart block, from first-degree heart block, which is the mildest, to third-degree, which is the most severe type.

What are the symptoms of heart block?

Tiredness and fatigue
Dizziness or lightheaded, feeling of fainting
Unsteady gait, shortness of breath, tiredness, and fatigue.
You may need help in doing day-to-day activities.
You may have shortness of breath.
Chest discomfort

What are the causes of heart block?

Age: Heart block is more common in older adults (>65 years).

Sex: Heart block is more common in males.

Medical condition and medicines:

Certain medical conditions: If you have ischemic heart disease, hypertrophic obstructive cardiomyopathy, amyloidosis and sarcoidosis, congenital heart disease, family history of heart block, hypothyroidism, hyperkalemia, Lyme disease.
Use of certain medications: You are at higher risk if you are on beta blockers, digoxin, adenosine, and antiarrhythmic drug, most commonly amiodarone.

What are the types of heart block?

There are mainly three types of heart block, first-degree, the mildest type, and third-degree, the most severe type.

First-degree heart block:

It usually doesn’t have any symptoms. All electrical impulses reach the ventricles despite being slowed through the conduction system. Well-trained athletes may have first-degree heart block. Some drugs can also bring on this syndrome. First-degree heart block typically does not require any treatment.

Second-degree heart block:

In this type, the electrical impulse doesn’t reach the heart’s lower chamber, and the heart may escape beats and become irregular. You may feel dizzy, faint, or have other symptoms.
This may be serious in some cases.

Third-degree heart block:

In this type, the upper and lower chamber of the heart doesn’t beat in a synchronized manner.
The upper and lower chambers do not beat sequentially (one after the other) as they ordinarily do, and the lower chambers beat at a significantly slower rate.
The heart is unable to supply the body with enough blood. Breathlessness and dizziness may result from this.
This is an emergency that needs medical help right away.

How will your doctor diagnose heart block?

Your doctor will talk to you about the symptoms that a heart block could cause.
Your doctor will do ECG to look for any irregularities in the heart.
It’s crucial to record your activities and symptoms accurately while using a Holter monitor; therefore, keep a journal. Write down the time of day they started and what you did in your diary if you experience symptoms like chest discomfort, shortness of breath, irregular heartbeats, or dizziness. The variations in your ECG captured by the Holter monitor will be compared to the entries in your diary. Sometimes your doctor also may ask you to wear a Holter machine for 24-48 hours to monitor any irregularities.

How will your doctor treat heart block?

Treatment depends upon the type of heart block. Firstly, your doctor finds out about the kind of heart block.

If you don’t have any severe symptoms, you need regular follow-ups with your doctor.
Your doctor may prescribe a wearable device to monitor your heart’s electrical activity, even at home.
If you have second or third-degree heart block, you may need a pacemaker. It is a small battery-operated device that senses when your heart is beating too slowly or irregularly. It sends a signal to your heart which will correct the heart’s pace.