Complete Heart Block

Ambiga*

Senior Staff Nurse, Kauvery Heartcity, Trichy, India

*Correspondence: +91 85086 98000; nursing.heartcity@kauveryhospital.com

Abstract

A retired 78-year-old man experienced giddiness and chest pain. They initially went to a local nearby clinic and received emergency care. They made the diagnosis of Complete Heart Block there and transferred the patient to our facility for additional care. By using PPI, we were able to safe guard the patient’s life.

Complete Heart Block

Complete heart block happens when the electrical signal from the atria, or top chambers of the heart, to the ventricles, or lower chambers, does not flow correctly. Complete heart block may occur if the atrioventricular (AV) node is harmed during surgery. Complete heart block can occasionally happen on its own without needing surgery.

Types of CHB

(1). The first-degree heart block: As the electrical signals travel from the atria to the ventricles, they become slow. First-degree heart block might not need any form of medical intervention.

(2). Second-degree heart block: The electrical signals between atria and ventricles sporadically fail to conduct. Two varieties of second-degree heart blocks exist.

Type I Mobitz: Between each beat, the electrical signals become progressively slower, till one beat drops put.

Electrical signals occasionally reach the ventricles and occasionally do not in Mobitz type II. The electrical signal is not gradually slowed. There is a danger of failure of transmission of electrical signals – an electrical failure which may lead to cardiac arrest

(3). Third degree heart block can frequently develop from this kind of heart block. The most serious heart block is a third-degree block. No electrical signals are transmitted from atria to ventricles. They beat on their own.

Causes of Complete Heart Block

The most common cause of heart block is heart attack or coronary artery disease.

Other causes are:

  • Older age.
  • Cardiomyopathy.
  • Sarcoidosis
  • Lyme disease.
  • High potassium level.
  • Severe hyperthyroidism.
  • Certain hereditary neuromuscular disease.

Symptoms of heart block

The type of heart block determines the symptoms. A dangerous third-degree heart block could result in

  • Intense fatigue
  • Abnormal heartbeats
  • Dizziness
  • Fainting

Case Presentation

Our patient Mr. XXX had chest pain and giddiness only and does not have any other known disease

Past History

The patient had complaints of chest pain for the past 6 months.

On Examination

BP: 90/60mmHg CVS: S₁ S₂
HR: 30/mt RS: B/LAE
SpO2: 97% P/A: Soft
Temp: 983.4°F CNS: NFND

Diagnostic measures

  • General health and medical history with special reference to heart disease
  • A medical checkup
  • Heart’s electrical impulses were recorded by an electrocardiogram (ECG).
  • To track the heart’s rhythm over time, a Holter or event monitor test is used. The patient may wear an event monitor for a month or longer or a Holter monitor for 24 or 48 h. These aid in capturing heart rhythm alterations, when they don’t happen frequently or reliably.
  • Small heart recorder can be implanted, called an implantable loop recorder.
Small-heart-recorder

ECG Findings

  • Atrial rate is ~ 85 bpm
  • Ventricular rate is ~ 38 bpm
  • More P waves than QRS complexes exist between them.
  • The escape rhythm may arise within the AV node (resulting in a narrow QRS complex) or lower in the conduction system (Producing a wide QRS complex).

Pre ECG (Before PPI)

Pre-ECG

Post ECG (After PPI)

Post-ECG

Management

With diagnostic findings of the patient, the doctor advised him for Permanent Pacemaker Insertion (PPI) procedure.

Pacemakers are devices that can be placed in the body, usually by surgery, to support the electrical system in the heart. They can stabilize abnormal heart rhythms and prevent problems that can disrupt or endanger life.

PPI illustration Image:

PPI-illustration-Image

Nursing Management

  • Determined the patient’s general state of health.
  • Important parameters are examined and noted.
  • Monitors were immediately attached.
  • Labs receive blood samples for examination.
  • Set up every step required for PPI operations.
  • The consultant described the patient’s situation to the patient attendants and gained their consent before starting the procedure.
  • The nurses comfort the sufferer with their kind remarks.
  • Stress was lessened.
  • We established a stressfree environment for the patient and gave them a comfortable position.
  • In order to continue the procedure, we need the patient’s and their attendants’
  • Cooperation
  • Provide enough oral liquids to prevent dehydration.
  • Outlining PPI’s potential future therapies.
  • Thye patient was sent to cath lab on his second day of hospitalisation after per operative preparation
  • The process proceeded smoothly
  • After that, the patient was sent to the CCU for emergency management.
  • For this patient, there was no postoperative problem.
  • Throughout his time in the CCU, he was content.
  • Next, we shifted him to the General ward.
  • The patient was discharged on the third day after admission.
  • As suggestions, we provided specific instructions on how to use PPT.

Tips to live with PPI

We adviced the patient to follow these instructions to improve the quality of life with a pacemaker:

  • Avoid being around electrical equipment or anything with strong magnetic fields where the pacemaker could be interfered with.
  • Carry a card identifying the type of pacemaker you have.
  • Inform all medical personnel that the patient is wearing a pacemaker.
  • Regularly check your pacemaker to ensure it is functioning properly.
  • Keep active but stay away from contact sports.
  • Don a medical alert necklace or bracelet.

Conclusion

We saved the life of an old and energetic person. We received a good outcome because of our effective treatment and also received the great blessings from the patient with his smiling face. Happily he returned to his home.

Ambiga

Ms. Ambiga

Senior Staff Nurse

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