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Atrioventricular block

Última revisão: 19 Jun 2025
Última atualização: 25 Jan 2023

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • age >50-60 years
  • underlying cardiovascular factors
  • syncope
  • heart rate <40 bpm
  • presyncope
Detalhes completos

Outros fatores diagnósticos

  • male gender
  • fatigue
  • dyspnea
  • chest pain, palpitations, and nausea or vomiting
  • high (less commonly, low) blood pressure
  • cannon A waves
  • hypoxemia
  • family history of AV block
  • features of Lyme disease
Detalhes completos

Fatores de risco

  • age-related degenerative changes in the conduction system
  • increased vagal tone
  • AV-nodal blocking agents
  • chronic stable coronary artery disease
  • acute coronary syndrome
  • recent cardiac surgery, intervention, or ablation
  • congestive heart failure (CHF)
  • hypertension
  • cardiomyopathy
  • left ventricular hypertrophy
  • acid-base or electrolyte disturbance
  • neuromuscular disorders
  • sarcoidosis
  • giant cell myocarditis
  • cardiac tuberculosis
  • lyme disease
  • infective endocarditis
  • hypoxemia
  • blunt cardiac injury
  • some indigenous medicines
Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • 12-lead ECG
  • serum troponin
  • serum potassium
  • serum calcium
  • serum pH
  • serum digitalis level
Detalhes completos

Investigações a serem consideradas

  • 24-hour ambulatory monitoring or event monitoring
  • chest x-ray
  • transthoracic echocardiogram
  • serologic testing for Lyme disease
  • tilt-table testing
  • electrophysiology study
  • cardiac stress testing
  • coronary angiography
  • serum CK-MB
Detalhes completos

Algoritmo de tratamento

AGUDA

first-degree AV block or type I second-degree AV block

type II second-degree AV block or third-degree AV block

Colaboradores

Autores

Sanjiv Petkar, MD, FRCP

Consultant Cardiologist/Electrophysiologist

Royal Wolverhampton NHS Trust

Heart and Lung Centre

New Cross Hospital

Wolverhampton

UK

Declarações

SP has received speaker's honoraria from Bayer, Bristol-Myers Squibb, MSD, and Pfizer. SP has received hospitality and/or accommodation from Bayer, Medtronic, St Jude, and Boston Scientific for attending conferences or meetings.

Dibbendhu Khanra, MD, DM Cardiology

International Clinical Fellow in Electrophysiology and Devices

Royal Wolverhampton NHS Trust

Heart and Lung Centre

New Cross Hospital

Wolverhampton

UK

Declarações

DK declares that he has no competing interests.

Gaurav Panchal, MBBS, MRCP

Specialist Registrar in Cardiology/Electrophysiology

Royal Wolverhampton NHS Trust

Heart and Lung Centre

New Cross Hospital

Wolverhampton

UK

Declarações

GP declares that he has no competing interests.

Agradecimentos

Dr Petkar, Dr Khanra, and Dr Panchal would like to gratefully acknowledge Dr Pathiraja, Dr Aziz, Dr Susan S. Kim, Dr John F. Beshai, and Dr Stephen L. Archer, previous contributors to this topic. JP, AA, SSK, JFB, and SLA declare that they have no competing interests.

Revisores

Bradley P. Knight, MD

Professor of Medicine

Section of Cardiology

Director

Cardiac Electrophysiology

University of Chicago Medical Center

Chicago

IL

Declarações

BPK declares that he has no competing interests.

Martin C. Burke, DO

Associate Professor of Medicine

Section of Cardiology

Cardiac Electrophysiology

University of Chicago Medical Center

Chicago

IL

Declarações

MCB declares that he has no competing interests.

Nick Gall, MSc, MD, FRCP

Consultant Cardiologist

King’s College Hospital

London

UK

Declarações

NG declares that he has no competing interests.

Thomas A. Dewland, MD

Associate Professor of Medicine

University of California

San Francisco

CA

Declarações

TAD declares that he has no competing interests.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2019 Aug 20;140(8):e382-482.Texto completo  Resumo

Tracy CM, Epstein AE, Darbar D, et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. Heart Rhythm. 2012 Oct;9(10):1737-53.Texto completo  Resumo

Glikson M, Nielsen JC, Kronborg MB, et al; ESC National Cardiac Societies; ESC Scientific Document Group. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021 Sep 14;42(35):3427-520.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Atrioventricular block images
  • Diagnósticos diferenciais

    • Junctional rhythm
    • Supraventricular tachycardia (SVT)
    • Atrial fibrillation or multifocal atrial tachycardia (MAT)
    Mais Diagnósticos diferenciais
  • Diretrizes

    • 2022 AHA/ACC/HFSA guideline for the management of heart failure
    • 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy
    Mais Diretrizes
  • Folhetos informativos para os pacientes

    Atrial fibrillation

    Heart attack

    Mais Folhetos informativos para os pacientes
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