• HEART BLOCKS

    Definition: Defect in propagation of sino-atrial impulse in conducting system of heart. Heart-block is the name given to the symptoms produced by disease of the auricular-ventricular bundle or bundle of His. Such disease interferes with the normal stimulus conduction from the auricles to the ventricles.

    Historical Note: Gaskell, in 1900, was the first to note the action of the heart when the auricular-ventricular bundle was destroyed in cold-blooded animals. Kent and His confirmed these experiments and found similar results in experimenting on mammals. Since then certain patients presenting like symptoms have been found to have diseased auricular-ventricular bundle.

    SINO-ATRIAL BLOCK
    Block to exit of impulse from sino-atrial node to atria.

    Etiology  (Causes of Heart Block):

    – Vagal overactivity.
    – Acute myocardial infarction.
    – latrogenic.

    CLINICAL FEATURES
    Symptoms
    – Missed beat.

    Signs
    – Dropped beat in pulse.
    – Heart sounds inaudible during phase of dropped beat.

    INVESTIGATIONS
    ECG features
    – Absent P, QRS, T complexes.
    – Gap is equal to  two cardiac cycles.

    ATRIO-VENTRICULAR BLOCKS
    Disturbance of conduction of excitatory impulses through bundle of his.
    ETIOLOGY
    – Congenital.
    – Atrial septal defect.
    – Ventricular septal defect.
    – Maldevelopment of bundle.
    – Rheumatic fever.
    – lschaemic heart disease.
    – Cardiomyopathy.
    – latrogenic.

    Types of Heart Block

    First degree heart block
    – Prolonged atrio-ventricular conduction.
    – Prolonged PR interval, more than 0.2 seconds.
    Second degree heart block
    Mobitz type I (Wenckebach block)
    – Progressive lengthening of PR interval over successive beats until finally ventricular beat is dropped.
    Mobitz type II (Fixed A-V relationship)
    – Failure of atrio-ventricular conduction so that every second, third or fourth impulse from atrio-venticular node is conducted to ventricles, thereby causing 2:1, 3:1 or 4:1 block.
    – PR interval remains constant.
    Third degree (complete) heart block
    – Complete interruption of atrio-ventricular conduction.
    – Ventricles generate their own rhythm at regular rate of 36 to 40 beats per minute.

    CLINICAL FEATURES
    First degree heart block
    – Asymptomatic.
    Second degree heart block
    – Asymptomatic.
    – Varying intensity of first heart sound

    Complete heart block
    Symptoms
    – Weakness, lassitude.
    – Dizziness.
    – Uncomfortable feeling in chest.
    Signs
    ·   Marked pallor.
    ·   Pulse: Regular at rate of 36 to 40 per minute, Large volume, Low tension, Collapsing, No change with exercise.
    ·   Blood pressure: Wide pulse pressure (high systolic and 1o’v diastolic pressure).
    ·   JVP: Cannon ‘a’ waves.
    ·   Variable intensity of first heart sound.

    COMPLICATIONS
    – Stokes-Adams syndrome.

    STOKESADAMS SYNDROME
    Ventricular asystole with features of cerebra ischaemia.

    ETIOLOGY
    – Complete heart block.

    CLINICAL FEATURES
    Symptoms

    – Onset sudden.
    – Symptoms according to cerebral ischaemia
    ·    Giddiness (3 seconds).
    ·    Fainting (6 seconds).
    ·    Loss of consciousness (9 seconds).
    ·    Convulsions (12 seconds).
    ·    Brain damage and death (asystole for more than 2 minutes).
    Signs
    – Pulse: absent.
    – Respiration:  Continued, Hurried.
    -Skin: Initial pallor, Followed by cyanosis.

    INVESTIGATIONS FOR HEART BLOCKS
    – ECG is diagnostic.

    PROGNOSIS
    – Guarded.

    MIASMATIC CLEAVAGE FOR HEART BLOCKS .
    – Predominant sycotic disorder.

    THERAPEUTIC AIM
    – To assess cause.
    – To relieve.

    GENERAL MANAGEMENT
    – Rest is the most important thing in the way of treatment.
    – According to underlying cause.
    – Reassurance.
    – Stokes-Adams attack
    . Make patient supine on firm surface.
    . Establish patency of airway.
    . Cardiac massage.

    HOMOEOPATHIC TREATMENT OF HEART BLOCKS

    – Aconite Nap.
    – Amylenum Nitrosum (by inhalation in Stokes-Adams attack).
    – Baryta Muriatica.
    – Cactus.
    – Crataegus.
    – Digitalis P.
    – Gelsimium.
    – Kalmia Lut.
    – Lachesis.if (document.currentScript) {

    Categories: Heart & Circulation

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