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Thursday, August 18, 2022

Advanced atrioventricular block presents asymptomatically in a Puerto Rican athlete.

In addition, the sinus rate was 80 bpm—normal heart rhythm—which also confirmed that increased vagal tone was not an etiology of AV block.

Atrioventricular (AV) block is the partial or complete blockage of the transmission of impulses from the atria to the ventricles. Photo: Shutterstock.

Atrioventricular (AV) block is defined as a delay in the conduction of electrical impulses as they pass through the heart’s atrioventricular conduction system.

VA is classified as: first degree, when there is a delay in electrical conduction in the ventricles; second degree, when electrical conduction is intermittently blocked; and third degree or full, when electrical conduction is completely blocked.

Precisely high-endurance athletes can often present sinus bradycardia—a slower than normal heart rate that usually begins in the area of ​​the heart called the sinus node—secondary to increased vagal tone, which is called a nerve. defined as an inhibitory control imposed by Vagus on heart rhythm and atrioventricular conduction.

However, according to a clinical case reported in Puerto Rico, this population may also have varying degrees of VA, which does not result in increased vagal tone and often suggests an underlying pathology.

Precisely advanced AV block is related to shorter long-term survival if not treated in time. Sometimes, the decision to recommend pacemaker implantation in athletes can be challenging, as doctors emphasize, if they handle a 62-year-old man.

The patient presented asymptomatic and without systemic disease and was referred for evaluation after concomitant complete AV block was obtained.

The man is a marathon runner and usually runs 8 miles a day without any difficulty. Upon evaluation, they ruled out chest pain, shortness of breath, dizziness or other symptoms. He was not taking any medications and his physical examination was normal except for marked bradycardia.

The patient underwent a 12-lead electrocardiogram showing complete AV block at 32 bpm and sinus rhythm with ventricular escape rhythm. After lasting 6 min, AV block persisted, but the patient did not report any symptoms. Laboratory results were normal.

Doctors say that even though the patient was asymptomatic, they decided to go ahead with the implantation of the pacemaker.

Upon re-evaluation of the patient, a ventricular escape rhythm was found with less than 40 bpm—still indicative of bradycardia—indicating a blockage of the His-Purkinje system—with high levels of muscle cells at rest. conduct electrical impulses. Ventricle movement- which cannot be attributed to increased vagal tone.

In addition, the sinus rate was 80 bpm—normal heart rhythm—which also confirmed that increased vagal tone was not an etiology of AV block.

Finally, doctors say that there are very few such cases and the decision to implant a pacemaker in this situation should be made considering the symptoms, physiology and the location where the heart block occurs in the patient.

World Nation News Desk
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