Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- idade >50-60 anos
- síncope
- frequência cardíaca <40 bpm
- pré-síncope
Other diagnostic factors
- sexo masculino
- fadiga
- dispneia
- dor torácica, palpitações e náuseas ou vômitos
- pressão arterial elevada (menos comumente, baixa)
- ondas A em canhão
- hipoxemia
- história familiar de bloqueio AV
- características da doença de Lyme
Risk factors
- alterações degenerativas no sistema de condução relacionadas à idade
- tônus vagal elevado
- agentes bloqueadores do nó AV
- doença arterial coronariana crônica estável
- síndrome coronariana aguda
- cirurgia, intervenção ou ablação cardíaca recente
- insuficiência cardíaca congestiva (ICC)
- hipertensão
- cardiomiopatia
- hipertrofia ventricular esquerda
- distúrbio ácido-básico ou eletrolítico
- distúrbios neuromusculares
- sarcoidose
- miocardite de células gigantes
- tuberculose cardíaca
- doença de Lyme
- endocardite infecciosa
- hipoxemia
- lesão cardíaca contusa
- alguns medicamentos indígenas
Diagnostic tests
1st tests to order
- eletrocardiograma (ECG) de 12 derivações
- troponina sérica
- potássio sérico
- cálcio sérico
- pH sérico
- nível digitálico sérico
Tests to consider
- monitoramento ambulatorial por 24 horas ou monitoramento de eventos
- radiografia torácica
- ecocardiografia transtorácica
- teste sorológico para doença de Lyme
- teste da mesa inclinável
- estudo eletrofisiológico
- teste ergométrico cardíaco
- angiografia coronariana
- creatina quinase-MB (CK-MB) sérica
Treatment algorithm
bloqueio atrioventricular (AV) de primeiro grau ou bloqueio AV de segundo grau tipo I
bloqueio atrioventricular (AV) de segundo grau tipo II ou bloqueio AV de terceiro grau
Contributors
Authors
Sanjiv Petkar, MD, FRCP
Consultant Cardiologist/Electrophysiologist
Royal Wolverhampton NHS Trust
Heart and Lung Centre
New Cross Hospital
Wolverhampton
UK
Disclosures
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
Disclosures
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
Disclosures
GP declares that he has no competing interests.
Acknowledgements
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.
Peer reviewers
Bradley P. Knight, MD
Professor of Medicine
Section of Cardiology
Director
Cardiac Electrophysiology
University of Chicago Medical Center
Chicago
IL
Disclosures
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
Disclosures
MCB declares that he has no competing interests.
Nick Gall, MSc, MD, FRCP
Consultant Cardiologist
King’s College Hospital
London
UK
Disclosures
NG declares that he has no competing interests.
Thomas A. Dewland, MD
Associate Professor of Medicine
University of California
San Francisco
CA
Disclosures
TAD declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Ritmo juncional
- Taquicardia supraventricular (TSV)
- Fibrilação atrial ou taquicardia atrial multifocal (TAM)
More DifferentialsGuidelines
- 2022 AHA/ACC/HFSA guideline for the management of heart failure
- 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy
More GuidelinesPatient information
Fibrilação atrial: quais são as opções de tratamento?
Fibrilação atrial: o que é?
More Patient information
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