Symptoms of heart block in India - Causes and treatment options

The heart runs on an electrical system. With every heartbeat, an electrical signal moves from the upper to the lower chambers, signalling your heart muscle to pull inwards to pump blood around the body. When these electrical impulses slow down or are unable to send a message, it causes a ‘heart block.’

How does a heart block develop?

Every heart muscle contraction is monitored by electrical signals conducted from the upper chambers of the heart (atria) to its lower chambers (ventricles). These are generated at regular intervals by the Sinoatrial Node (SA Node), which contains specialized cells.

For practical purposes, you can think of the SA Node as a natural pacemaker. Every electrical impulse allows the heart to beat and pump fresh blood throughout the body. The signal is then sent to the Atrioventricular Node (AV node) which further conducts the impulse, into the two lower chambers – or ventricles – of the heart.

A heart block occurs if the transmission of the electrical impulse between the AV node and the ventricles is disrupted, wholly or partially. It is also referred to as AV block (atrioventricular block).

Though there are back-up systems that can take over, a heart block can lead to the body organs and becoming deprived of oxygen.

The type of heart block present in a person will determine the symptoms that one may experience. However, the common symptoms of heart block are dizziness, fainting, chest pain and fatigue with an irregular heartbeat.

Different signs of arterial blockage

While first degree heart block may not have any noticeable signs, the symptoms of second degree heart block include:

The third degree heart block treatment is absolutely neccessary. A person may experience the following signs of arterial blockage:

Complications caused by heart block

A heart block may cause internal complications in the affected person, especially if it goes untreated. The complications may include:

• Low blood pressure
• Damage to internal organs due to inadequate blood supply caused by erroneous functioning of the heart with a block
• Heart attacks/Cardiac arrest
• Injuries sustained during loss of consciousness

If you recognize these symptoms, it’s best to visit a
cardiologist right away. The doctor will conduct a detailed diagnosis into your condition, identify the cause and offer treatment accordingly.

COVID in India and heart block 

The mutated variation of COVID-19 outbreak in India is spreading rapidly claiming several thousand lives across the country. Some of the common symptoms of COVID-19 are

• Difficulty in breathing
• Fever
• Headache and body pain
• Loss of smell and taste

Though it is known that novel coronavirus affects the lungs and causes shortness of breath, new studies say that the deadly virus can injure the heart as well. Research conducted among many patients concluded that novel coronavirus could increase the risk of blood clots in patients. This factor was noticed among many people who recovered from COVID in India, especially aged above 60, giving them a higher risk of heart diseases like a heart attack in the future. It is of dire importance to get the COVID-19 vaccine on time and prevent avert any major lung or heart diseases. The COVID-19 vaccine is highly effective and currently being administered to all Indian citizens.

Types of heart block

• First degree:

In a first degree heart block, although the electrical impulse moves slower than usual through the AV node, it still completes the signal. It is a mild type of heart block which usually does not cause any noticeable symptoms and may even go unnoticed.

It involves slight disruptions to the heartbeat and is not severe enough to require treatment. This type of heart block is particularly common in athletes and those on drugs such as beta-blockers etc.

• Second Degree:

Second degree heart block is classified into two categories:

Mobitz Type I block – It is a less severe form of second degree heart block. The heart rate continuously slows down to an extent where the heart drops a beat. The cycle then repeats itself. It is also called Wenckebach’s phenomenon. It is sometimes observed at rest or during sleep in athletic individuals.

Mobitz Type II block – In this condition, some of the electrical signals fail to reach the ventricles and have an irregular pattern. It is also characterized by a heartbeat that is slower than usual. One in 30 people develop Mobitz Type 2 heart block.

• Third Degree:

It is also referred to as a complete heart block. In the third-degree heart block, the conduction of electrical signals wholly fails. The heart rate is either very low or may even stop entirely. It can come down to 40 times a minute. A third-degree heart block is either congenital (present at birth) or acquired (develops later in life due to some heart damage).

This type of blockage requires quick heart blockage surgery treatment as it can prove fatal. It is often present in patients who have underlying heart disease.

A heart block can develop due to varied causes.

It can also be present at birth in some individuals. Understanding the risk factors and causes of heart block is important to preventing them to some extent.

Risk factors and causes of heart block

• Congenital heart block:

A congenital heart block implies that a person is born with the condition. It may be caused by:

Birth defect

This condition may develop at birth due to some abnormality during foetal development. The precise causes of clogged arteries in birth is difficult to identify.

Hereditary causes

Autoimmune diseases like lupus (inflammation of body tissues) may pass on from the mother to the child during pregnancy through the umbilical cord. It may be one of the causes of clogged arteries in the child by birth.

• Acquired heart block:

A heart block that develops later in life, due to some damage caused to the heart or, a side-effect of some ongoing medicine, is termed as an acquired heart block. Most common reason of heart blockage are due to acquired causes. The causes and risk factors include:

Damage to the heart from previous conditions

• A previous heart surgery to remove blockage that impacts the electrical impulses of the heart
• Damage caused due to a heart attack
• Cardiomyopathy- enlarged heart condition
• Coronary heart disease – when the heart is short of blood supply
• Trauma or injury to the chest
• Myocarditis- inflammation of the heart muscle
• Certain muscle disorders
• Sarcoidosis
• Severe hyperthyroidism
• Lyme disease- a bacterial infection spread by ticks
• Radiotherapy side-effect
• Cancer that spreads from another part of the body to the heart

Medications that can cause heart block

• Beta-blockers and calcium channel blockers – Calcium channel blockers increase retention of fluid in your tissues
• Antidepressants – Antidepressants can cause dangerous side effects related to the cardiovascular system. Some of these negative side effects include bradycardia, hypertension and heart block
• Digoxin- This is used to slow a rapid heartbeat, but can worsen arrhythmia

Moreover, a heart block can also be a result of old age as the ability of the heart to work effectively reduces with advancing age.

You may want to see a cardiologist if you experience any of the associated signs of blockage in heart.

While the diagnosis of first degree heart block may happen during some routine tests, second and third-degree heart blocks require a careful diagnosis with some specific tests.

The steps taken for a heart block diagnosis include:

Initial examination

Firstly, the doctor enquires about your medical history to analyze your general heart health. The doctor may consider the following factors:

You will then undergo a physical examination in which the doctor will check your pulse rate. The heart specialist will use the stethoscope as well to evaluate your heart sounds and also evaluate your legs or feet for any fluid retention as it can be a sign of heart damage.

Diagnostic tests for heart block

After an initial evaluation of your heart health, your doctor may use one or some of the below-mentioned tools to carefully assess a heart block:

Electrocardiogram (ECG/EKG)

An ECG machine records the electrical activity of the heart. It is the most common test adopted by doctors to detect problems with the heartbeat. It is a safe, non-invasive procedure in which up to 12 sensors are attached to your chest to record electrical signals.

The sensors are electrodes with wires attached to a monitor which displays the recorded electrical signals, which then can be printed and stored as a report. The entire process just takes a few minutes to complete.

Holter monitor

It is a type of ambulatory electrocardiogram, a portable device that records your heart’s electrical activity continuously for up to 48 hours or longer as recommended by the doctor. It is attached to your skin as you go about doing your daily activities. Your doctor may also ask you to keep a log of your daily activities and symptoms.

While a usual ECG measures heart activity at a specific point of time, a Holter monitor records data over time. An irregular heartbeat can come and go at irregular intervals. Thus, it is better to have detailed data for an accurate diagnosis.

After the test period, the concerned specialist will process the data recorded and prepare a report.

Echocardiogram (Echo)

It is an ultrasound scan of the heart, which enables the doctor to check if the heart muscles and valves are working. Echocardiogram uses sound waves to produce moving pictures of the heart so the doctor can assess its size, shape and diagnose the condition accordingly.

Implantable loop recorder

It is an ultrasound scan of the heart, which enables the doctor to check if the heart muscles and valves are working. Echocardiogram uses sound waves to produce moving pictures of the heart so the doctor can assess its size, shape and diagnose the condition accordingly. It also helps measure the pressure of blood flow in the chambers and blood vessels.

Electrophysiology test

It is an invasive test in which thin, flexible wires are attached from your groin or arm to your heart. It uses minor electrical shocks that help in determining the reason for heart blockage and its exact location.

Tilt-table test

In a tilt-table test, the doctor will ask you to lie on a specific table that is slowly tilted upward to an approximate angle of 60 to 80 degrees while monitoring your blood pressure and heart rate. It helps your doctor to check for changes in your heart rate/BP in response to shifting positions quickly for efficient diagnosis. It also helps in determining the reason for heart blockage.

The doctor usually performs the above tests in combination with a blood test. A blood test will help the doctor in ruling out any underlying hormonal issues or systemic diseases and infections like Lyme disease etc. that may be causing a heart block.

Preparing for an appointment

Before undergoing any of the diagnostic tests, it is vital to talk to your doctor for the necessary preparation required for the test.

However, some general tips include:

• Wear comfortable and loose clothing
• Do not eat or drink anything at least two hours before the test
• If you are on some medication, ask your doctor if it is alright to take it before the test as it may impact the test reports.

The best treatment for heart block depends on the underlying cause and the severity of your symptoms.

Immediately after the cause is treated, the symptoms of heart block slowly go away.

After carefully analyzing the diagnostic test reports, the cardiologist works out a treatment plan that will suit you the best.

First degree heart block treatment

As discussed earlier, first degree heart block does not cause any noticeable symptoms and hence usually does not require any treatment plan.

Second degree heart block treatment

For second degree heart block treatment, patients may be prescribed heart block medication and may or may not require treatment depending on the symptoms seen in each case.

The doctor may not recommend any treatment for Mobitz type I heart block, but for patients with Mobitz type 2 treatment is required. The various treatment of heart block have been discussed further in the article.

Third degree heart block treatment (Complete heart block treatment)

A third-degree heart block is a serious heart concern that essentially requires medical attention. It can prove to be of fatal consequences if it goes unattended.

The treatment and management options, available in case of a heart block include:

Treatment and heart block management

1. Medications
After carefully reviewing your ongoing medications, if your doctor feels any of them is causing your heart rate to slow down, you will be advised to either discontinue its use or get the medication changed. You will be able to see a relief in the symptoms of heart block soon after.
Additionally, the doctor may give you heart block medication like certain anti-arrhythmic drugs. These drugs help prevent abnormal automaticity of other sites in the heart from producing irregular electrical impulses. The main goal of antiarrhythmic drugs would be to restore normal heart rhythm and electrical conduction of impulses.

2. Follow-up electrophysiology study
The follow-up ensures that the medication is effective. The objective is to find a heart blockage treatment without surgery or combination of drugs that works best for your condition.

3. Transcutaneous Pacing (TCP)
A TCP helps in restoring a normal heartbeat and is considered a temporary subsitute for heart blockage surgery. In this, pads attached to the chest deliver the electrical signals to the heart. It is a temporary method of pacing used during medical emergencies to normalize the heartbeat. Sedation is required for the procedure to make the person drowsy.
The doctor fits a pacemaker after your heartbeat returns to normal.

4. Pacemaker
A pacemaker is the most common method used for partial or complete heart block treatment. It is a small electrical device, usually placed on the chest to enable normal heartbeat in the person.
It is a battery-operated device which automatically senses when your heartbeat is too slow or irregular and stabilizes it. The doctor implants the device under the chest skin, and the whole procedure takes around one hour in most cases. A person usually goes home within 24 hours.

5. Implantable Cardioverter Defibrillator (ICD)
The primary use of ICD is for people affected by rapid heart rhythms. It is very helpful in monitoring heart rhythm. It is slightly bigger than a pacemaker and can deliver electric shocks directly to the heart when it determines that the heart rate is too fast, and even if it is too slow.
One needs to take certain precautionary measures if you have a pacemaker or ICD installed in your body:

• Keep distance from electrical devices with strong magnetic fields like MRI machines.
• Let all your healthcare providers know about the device
• Though physical activity is crucial, your doctor may recommend you to stay away from vigorous sports like football for some time
• Regularly get your device checked by the doctor to make sure it is working fine.

6. Making diet and lifestyle changes

Though a heart block is not always avoidable, simple diet and daily lifestyle changes can prove to be beneficial in preventing the condition to some extent.

It is a great way to manage your heart condition, especially for those with first and second degree symptoms of heart block. Even those who are getting third degree heart block treatment like angioplasty should surely consider making healthy changes to their eating habits by following a proper diet after angioplasty to see a positive impact on their overall heart health.

The following tips may help in improving your condition:

For those looking for natural remedies for heart blockage without surgery, managing your diet and lifestyle is not just a great way to treat various heart diseases but can also help prevent heart problems in the first place.

Q1. What is AV block?

For those searching for what is AV block, it refers to atrioventricular block. It is the same as a heart block where the electrical impulse travelling from the AV node is partially or completely blocked from reaching the ventricles. AV block symptoms include dizziness, fatigue, breathing difficulty, chest pain, and more. If you experience any of these AV block symptoms, consult a cardiologist immediately.

Q2. What is the most common cause of heart block?

The most common cause of heart block is scarring of the heart tissue with advancing age or heart damage due to some underlying condition.

Q3. How common is a heart block?

Third-degree or complete heart blocks occur in 5 to 10% of people over 70 years of age. First degree and Mobitz type I heart blocks happen in 0.5 to 2% of otherwise healthy adults. On the other hand, Mobitz type II heart block is more common in people with underlying heart conditions. 1 in 30 such people develop this type of heart block.

Q4. Can a heart block be prevented?

For those looking for natural remedies for heart blockage without surgery, managing your diet and lifestyle is not just a great way to treat various heart diseases but can also help prevent heart problems in the first place.

Q5. Which common methods are used to diagnose a heart block?

An Electrocardiogram (ECG/EKG) and Echocardiogram (Echo) are the most common diagnostic tests adopted to detect a heart block and also various other heart conditions.

Q6. Which are the most frequently recommended treatment methods for Mobitz type II and third-degree heart block?

Brisk walking, running, swimming, cycling, skipping, and other moderate-intensity sports are best to manage heart block conditions.

Q7. Can I prevent a heart attack?

Doctors often recommend implantable devices like a Pacemaker, ICD- Implantable Cardioverter Defibrillator for treating severe heart blocks. Once installed, these devices can work effectively for 5 to 7 years.

Q8. What are the symptoms of heart block?

While a first degree heart block does not have any noticeable symptoms, second and third-degree heart blocks may have symptoms like shortness of breath, palpitations, dizziness, fainting, pain or discomfort in the chest.

Q9. What is complete heart block and why is it an emergency?

In a complete heart block, the conduction of electrical signals wholly fails. The heart rate is either very low or may even stop entirely. It can come down to 40 times a minute. If left untreated, it can cause sudden cardiac arrest and even death.

Q10. What are the disadvantages of having a pacemaker?

A pacemaker is usually safe but may rarely cause infection at the installed site, sensitivity to the device material, failure of the device to produce timely electrical impulses.

Q11. What are the complications associated with heart block?

A heart block can cause complications such as low blood pressure, damage to internal organs and even cardiac arrest if left untreated.

In closing
For raising awareness among people regarding cardiovascular health and its related conditions, 29th September is observed as the World Heart Day. On this day, The World Heart Federation promotes heart-healthy lifestyles for a long and better quality life.

Cardiovascular health or heart health is one of the most important but often ignored parts of life. Understanding the symptoms of heart block can go a long way in keeping you healthy.

Regular medical checkups play a crucial role in early detection of heart conditions.