Heart Block Treatment in Delhi, India

Heart block, also known as atrioventricular (AV) block, is a problem that occurs when there is an abnormal heart rhythm. In this condition, the heart beats way too slow as compared to a normal beating rhythm, the heartbeat is driven with an electrical signal that comes from the sinoatrial node, located at the top of the right atrium. The signal travels through the atria and reaches the atrioventricular node, which tells the heart to contract and pump blood. Heart block occurs when this electrical signal is delayed or interrupted. It is also known as the atrioventricular block (AV block).

Heart block can be categorised into different types based on its severity and the extent of disruption in the electrical conduction system of the heart: 

First-degree heart block 

This is the mildest form of heart block where there is a delay in the conduction of electrical impulses between the atria (upper chambers) and the ventricles (lower chambers) of the heart. However, all impulses eventually reach the ventricles.

Second-degree heart block

In this type, some of the electrical impulses from the atria fail to reach the ventricles, resulting in skipped heartbeats or irregular rhythms. There are two subtypes: 

• Type I (Wenckebach): The electrical impulses progressively delay until one impulse is completely blocked, leading to a skipped heartbeat. 
• Type II: Occasional impulses fail to reach the ventricles without a progressive lengthening of the delay. 

Third-degree heart block (complete heart block) 

This is the most severe form of heart block where there is a complete blockage of the electrical impulses between the atria and ventricles. As a result, the atria and ventricles beat independently of each other, causing a slow and often irregular heartbeat.

A heart block can be caused by various factors that disrupt the normal transmission of electrical signals through the heart's conduction system. Here are some common causes of heart block: 

Heart Disease 

Heart block can occur as a result of underlying heart conditions, such as coronary artery disease, myocardial infarction (heart attack), cardiomyopathy (disease of the heart muscle), or congenital heart defects. These conditions can damage the heart's electrical conduction system, leading to disruptions in signal transmission. 

Age-Related Changes 

Aging can affect the heart's electrical system, increasing the risk of heart block. Fibrosis (thickening or scarring) of the heart's conduction pathways and degenerative changes in the heart tissue can contribute to the development of heart block in older adults. 

Medications

Certain medications, particularly those used to treat heart conditions, high blood pressure, or arrhythmias, can interfere with the heart's electrical conduction system and cause heart block. Examples include beta-blockers, calcium channel blockers, antiarrhythmic drugs, and some types of antibiotics. 

Infections 

Infections affecting the heart, such as myocarditis (inflammation of the heart muscle) or endocarditis (infection of the heart valves), can disrupt the heart's electrical pathways and lead to heart block. 

Autoimmune Disorders 

Autoimmune conditions, such as lupus or rheumatoid arthritis, can cause inflammation and damage to the heart tissue, including the conduction system, leading to heart block. 

Electrolyte Imbalances 

Abnormal levels of certain electrolytes, such as potassium, calcium, or magnesium, can affect the heart's electrical activity and increase the risk of heart block. 

Trauma or Surgery 

Injuries to the chest or heart surgery procedures, such as valve replacement, can damage the heart's conduction system and result in heart block. 

Genetic Factors 

Some individuals may inherit genetic mutations that predispose them to certain types of heart block, such as congenital heart block. This type of heart block may occur in newborns or develop later in life. 

Harmful Chemical Exposure 

Exposure to certain toxins or chemicals, such as heavy metals or pesticides, can damage the heart tissue and disrupt its electrical conduction system, leading to heart block. It's important to note that the specific cause of heart block may vary from person to person, and in some cases, the exact cause may not be identified. Prompt evaluation and appropriate management by a healthcare professional are essential for individuals experiencing symptoms of heart block.

Symptoms of heart block can vary depending on the severity and type of blockage, as well as individual factors such as overall health and age. Here are some common symptoms associated with heart block: 

Fatigue 

Feeling unusually tired or fatigued, even with normal daily activities, is a common symptom of heart block. This fatigue may not improve with rest. 

Dizziness or Lightheadedness 

Heart block can cause reduced blood flow to the brain, leading to feelings of dizziness or lightheadedness, especially when standing up quickly or exerting oneself. 

Fainting (Syncope) 

In more severe cases of heart block, where there is a significant disruption in the heart's electrical signals, fainting episodes may occur. These episodes are typically brief and may be preceded by symptoms such as dizziness or lightheadedness. 

Shortness of Breath 

Heart block can impair the heart's ability to pump blood effectively, leading to a buildup of fluid in the lungs and causing shortness of breath, especially during physical activity or when lying flat.

Chest Pain or Discomfort

Some individuals with heart block may experience chest pain or discomfort, often described as a tightness, pressure, or squeezing sensation in the chest. This symptom may be mistaken for angina or a heart attack. 

Palpitations 

Heart block can cause an irregular heartbeat or palpitations, where you may feel like the heart is racing, fluttering, or skipping beats. 

Difficulty Exercising 

People with heart block may find it challenging to engage in physical activities or exercise due to symptoms such as fatigue, shortness of breath, or palpitations. 

Weakness 

Weakness or a general feeling of malaise may occur in individuals with heart block, particularly if the heart's pumping function is compromised. 

It's important to note that some individuals with heart block may not experience any symptoms, especially if the blockage is mild or if the heart's compensatory mechanisms are able to maintain adequate blood flow. However, even asymptomatic cases of heart block require monitoring and appropriate medical management to prevent complications. If you experience any symptoms suggestive of heart block, it's essential to seek medical attention promptly for evaluation and treatment.

Diagnosing heart block typically involves a combination of medical history review, physical examination, and various diagnostic tests. Here's an overview of the diagnostic process for heart block: 

Medical History and Physical Examination 

The healthcare provider will begin by asking about the symptoms, medical history, and any risk factors for heart disease. They will also perform a physical examination, which may include listening to the heart with a stethoscope and checking for signs of heart abnormalities.

Electrocardiogram (ECG or EKG) 

An ECG is a primary diagnostic tool used to detect heart block. This non-invasive test records the electrical activity of the heart and can identify abnormalities in the heart's rhythm and conduction system. Different types of heart block, such as first-degree, second-degree, or third-degree heart block, can be diagnosed based on specific patterns seen on the ECG. 

Holter Monitoring 

In cases where symptoms of heart block are intermittent or occur infrequently, a Holter monitor may be used. This portable device continuously records the heart's electrical activity over a 24-hour period or longer, providing a more comprehensive assessment of heart rhythm abnormalities. 

Event Monitor 

Similar to a Holter monitor, an event monitor is a portable device that is worn for an extended period, but it is activated by the patient when symptoms occur. This allows for the recording of specific episodes of abnormal heart rhythm for further evaluation. 

Echocardiogram 

An echocardiogram uses sound waves to create images of the heart's structure and function. It can help identify underlying structural abnormalities in the heart, such as heart valve problems or structural heart disease, which may contribute to heart block. 

Stress Test 

A stress test may be performed to assess how the heart responds to physical exertion. During this test, you may walk on a treadmill or pedal a stationary bike while the heart rate, blood pressure, and ECG are monitored. Stress testing can help evaluate the heart's overall function and detect abnormalities in heart rhythm that may not be present at rest. 

Electrophysiology Studies

In certain cases, electrophysiology studies may be recommended to evaluate the heart's electrical system in more detail. During this invasive procedure, thin, flexible wires called catheters are inserted into the heart to measure electrical activity and identify the source of abnormal rhythms. Once a heart block is diagnosed, further testing and evaluation may be necessary to determine the underlying cause and severity of the condition. Treatment options can then be tailored to address the specific needs of each patient.

Treatment for heart block depends on the severity of the condition, the type of blockage, and the presence of symptoms. Here are some common treatment options for heart block: 

Observation and Monitoring 

In cases of mild or asymptomatic heart block, especially first-degree heart block, no specific treatment may be necessary. However, regular monitoring by a healthcare provider is essential to assess any changes in the condition over time. 

Pacemaker Implantation 

In more severe cases of heart block, particularly second-degree or third-degree heart block, pacemaker implantation may be necessary. A pacemaker is a small device implanted under the skin near the collarbone that helps regulate the heart's rhythm by sending electrical impulses to the heart muscle. This ensures that the heart beats at a regular rate and maintains adequate blood flow throughout the body.

If heart block is caused by underlying heart disease or other medical conditions, such as coronary artery disease or myocarditis, appropriate treatment of these conditions is essential to prevent progression of heart block and reduce the risk of complications. 

Treatment for heart block is individualised based on the specific needs and circumstances of each patient. It's important for individuals with heart block to work closely with their healthcare providers to develop a comprehensive treatment plan tailored to their condition and overall

health goals. Regular follow-up appointments are essential to monitor the effectiveness of treatment and make any necessary adjustments over time.

Heart block complications can range from mild to life-threatening, depending on the severity of the block. Here's a breakdown of potential issues: 

• Slow heart rate (bradycardia): This is the most common complication. A slow heart rate can cause dizziness, fatigue, shortness of breath, and even fainting spells. 
• Reduced blood flow: A slow heart rate means the heart isn't pumping blood as efficiently as it should. This can lead to lightheadedness, weakness, and even organ damage if left untreated. 
• Chest pain: In some cases, heart block can cause chest pain similar to angina. 
• Heart failure: Severe heart block can weaken the heart muscle over time, leading to heart failure. 
• Cardiac arrest: In the most serious cases, complete heart block can prevent the heart from beating effectively, potentially leading to cardiac arrest.

Unfortunately, there's no guaranteed way to prevent heart block. However, certain factors can increase one's risk. Here's how individuals can potentially reduce their risk: 

• Manage underlying conditions: If individuals have health conditions that increase their risk of heart block, such as coronary artery disease or heart valve disease, following their doctor's treatment plan is crucial. 
• Maintain a healthy lifestyle: Eating a heart-healthy diet, exercising regularly, and maintaining a healthy weight can all contribute to heart health and potentially reduce the risk of complications that might lead to heart block. 
• Regular checkups: Regular checkups with a healthcare provider allow for the monitoring of heart health and the early identification of any potential problems. 

It's important to note that while these practices can't directly prevent heart block, they can promote overall heart health and potentially reduce the risk of developing conditions that might contribute to it.

Can heart block come and go, or is it permanent?

Yes, heart block can be intermittent or permanent. In some cases, it occurs only under certain conditions, such as medication side effects or illness, and may resolve once the underlying trigger is removed. Other times, especially in more advanced forms, it can be permanent and require ongoing management.

Is heart block the same as a heart attack?

No, they are different conditions. Heart block is an electrical issue in the heart that affects the heartbeat, while a heart attack is caused by a blockage in the blood vessels supplying the heart muscle. However, a heart attack can sometimes lead to heart block if it damages the heart's electrical pathways.

Can stress cause heart block?

Stress does not directly cause heart block, but it can worsen underlying heart conditions and arrhythmias. Prolonged stress may also trigger symptoms in those already living with heart rhythm disorders.

Can heart block be detected during a routine check-up?

Yes, many cases of heart block are detected through routine electrocardiograms (ECGs), even in people without symptoms. If the irregularities are sporadic, longer-term monitoring like a Holter or event monitor may be needed.

Is heart block reversible?

Some cases of heart block are reversible, especially if caused by medication side effects, infections, or electrolyte imbalances. In other cases, particularly complete or congenital blocks, the condition is permanent and managed with devices like pacemakers.

Can I live a normal life with a pacemaker?

Yes, most people with a pacemaker lead full, active lives. With regular medical follow-ups and minor lifestyle adjustments, daily routines and physical activities can be resumed safely.

Does heart block always require surgery?

Not always. Mild forms of heart block may require only observation or medication adjustments. Surgery, such as pacemaker implantation, is typically reserved for more severe or symptomatic cases.

How does heart block affect children or newborns?

Congenital heart block can occur in infants and is sometimes associated with maternal autoimmune diseases. In some cases, it is well-tolerated, while in others, a pacemaker may be needed early in life.

Can heart block lead to stroke?

Heart block alone does not typically cause stroke, but it can coexist with other arrhythmias like atrial fibrillation, which does increase stroke risk. Monitoring and managing any coexisting rhythm disorders is important.

What should I avoid if I have a heart block?

People with heart block should avoid unapproved medications that may slow the heart rate further. Limiting alcohol, caffeine, and smoking is also recommended to support overall heart health.

Is exercise safe for someone with a heart block?

Exercise is generally safe for people with heart block, but activity levels should be discussed with a doctor. Tailored exercise plans can improve heart health while minimizing risk.

How often should someone with a heart block see a doctor?

Follow-up intervals vary depending on the type of block and treatment plan. Those with pacemakers typically require checkups every six to twelve months to monitor device performance and heart function.

Does heart block get worse over time?

In some cases, particularly certain second-degree blocks, the condition can progress to complete heart block. Early diagnosis and consistent follow-up are key to preventing complications.

Can heart blocks be genetic?

Yes, some rare forms of heart block are inherited and may affect multiple members of the same family. Genetic counseling and family screening may be considered in such cases.

Is heart block more common in men or women?

Heart block affects both men and women, though some types, like congenital heart block, are more often associated with autoimmune antibodies from the mother. Age is a more significant factor than gender in most cases.

Are there dietary changes that can help manage heart block?

A heart-healthy diet supports overall cardiovascular wellness and can reduce the risk of complications from coronary artery disease which can predispose to heart block. Diets low in salt, cholesterol, and processed foods are especially beneficial.

How long does a pacemaker last?

Pacemakers generally last between ten to fifteen years depending on usage and battery life. Replacing the device is a straightforward procedure and less invasive than the initial implantation.

Can I travel or fly with a pacemaker?

Yes, traveling is safe for most pacemaker patients. It is advisable to carry a pacemaker ID card and inform airport security to avoid prolonged exposure to metal detectors and magnetic fields.

What’s the recovery time after pacemaker surgery?

Most people recover within a few days to a week. Heavy lifting and strenuous activity are usually restricted for several weeks to allow the surgical site to heal properly.

Is heart block a disability?

In mild cases, heart block may not significantly affect daily function. More severe or symptomatic cases may interfere with physical activity and may qualify as a disability under certain conditions.

Reviewed by Dr. Sunil Sofat, Director - Interventional Cardiology & Electrophysiology/RF Ablation & Cardiac Pacing, Cardiac Sciences, Cardiology, Cardiac Electrophysiology-Pacemaker, on 27 May 2025.