Are you having problems with your heart rhythm? Let's talk about Heart Block!

Have you ever had chest pain, shortness of breath, or a feeling that your heart is beating abnormally? You may have felt dizzy or faint. These can sometimes be symptoms of a condition called 'heart block', which occurs when electrical signals in the heart don't travel properly. Today, we'll talk about this in detail, but simply, as if you were talking to a friend.

What is Heart Block? Simply put...

Think of it like a little motor that needs electricity to work. In the same way, our heart also has an electrical signal system to beat. These signals start from the two upper chambers of the heart (which we call `(Atria)`) and go to the two lower chambers of the heart (`(Ventricles)`). In between these upper and lower chambers, like a traffic light, there is a place that controls the signals. It is called the `(AV node)` (atrioventricular node).

Now, a heart block is when there is some kind of obstruction in the way that electrical signals travel from the top to the bottom of the heart. Maybe the signals travel slowly, or some of the signals don't get to the lower chambers, or the signals stop traveling completely.

What happens then? The heart may not work properly. The heart may beat slowly, and some beats may be skipped. In severe cases, this can interfere with the pumping of blood throughout the body, causing serious problems. This condition often occurs later in life, rather than being present at birth. This is also called ``Atrioventricular (AV) block`` and is sometimes called ``conduction disorder``.

Are there types of heart block?

Yes, these heart blocks can come in different forms and at different levels. That is, they are classified according to how much the electrical signal is blocked and how often it occurs.

• First-degree heart block: In this case, the electrical signal travels to the lower chambers of the heart (the ventricles), but a little slower. There is a slight delay as it passes through the AV node. This is the mildest type of block. Most people don't even know they have it.
• Second-degree (incomplete) heart block: In this, only some of the heart's electrical signals reach the lower chambers, not all of them. There are also two types of this:
• Type I, `(Mobitz Type I)` or `(Wenckebach's AV block)`: This is a slightly less serious type. The electrical signal slows down gradually, eventually skipping one heartbeat.
• Type II (Type II), `(Mobitz Type II)`: In this, even though most of the signals go to the chambers, sometimes some of the signals suddenly stop. Then the heartbeat becomes irregular, beating slower than normal. This is a little more serious , and you may need a `(Pacemaker)` (a small device that helps keep the heart beating at a regular rate).
• Third-degree heart block: This is a complete block. The electrical signals from the upper chambers of the heart (the atria) to the lower chambers (the ventricles) are not transmitted at all. This greatly affects the way the heart pumps blood to the body. This is a very serious condition , and treatment almost always requires a pacemaker.

What are the symptoms of this?

The symptoms of heart block can vary from person to person, depending on the severity of the block and how it affects the functioning of the heart.

Commonly seen symptoms are:

• Chest pain
• Tiredness, fatigue
• Difficulty breathing
• Feeling like your heart is beating fast (palpitations)
• Increased breathing rate
• Nausea
• Dizziness, feeling like you're spinning.
• Loss of consciousness (fainting)

However, people with first-degree heart block may not have any symptoms. It is sometimes discovered when a doctor does an electrocardiogram (EKG) during a routine checkup.

In third-degree heart block, symptoms can be very severe, as the heart rate slows down significantly. If you have severe symptoms, it is important to seek medical attention immediately.

What are the causes of heart block?

There are a number of factors that can contribute to heart block. Some of the main causes are:

• Heart attack
• Coronary artery disease (CAD)
• Heart muscle disease (`Cardiomyopathy`)
• Heart valve diseases
• Unexplained damage to the heart's electrical signaling system
• Congenital heart structural problems
• Heart damage during open heart surgery
• Side effects of some medications (e.g., medications like `(Beta-blockers)`, `(Digitalis)`, `(Calcium channel blockers)`)
• Exposure to toxins
• Obstructive sleep apnea (OSA)
• Thyroid disease
• Some infections, for example `(Lyme disease)`
• Autoimmune diseases
• Genetic abnormalities

Who is most at risk for this?

You may be at increased risk of having a heart attack if:

• If you have other heart conditions, such as coronary artery disease or heart valve disease.
• If you were born with a heart abnormality.
• If you have a disease that affects the heart, such as `(Rheumatic heart disease)` or `(Sarcoidosis)`.
• If your ``vagus nerve'' (a nerve that helps control your heart rate) becomes overactive and slows your heart rate.
• If you are taking medications that slow down the heart's electrical signals. This may include medications for heart disease and high blood pressure (e.g., `(Beta-blockers)`, `(Diuretics)`, `(Calcium channel blockers)`, `(Digoxin)`), medications for irregular heartbeats (`(Antiarrhythmics)`), muscle relaxants, sleeping pills, and medications for depression and mental illness.

What complications can this cause?

If heart blocks are not treated properly, they can lead to complications that can be life-threatening. These include:

• Heart failure (inability of the heart to pump enough blood to the body)
• Irregular heartbeat (`Arrhythmia`)
• Heart attack
• Sudden cardiac arrest (heart stopping suddenly)

How to diagnose heart block?

To find out if you have heart failure, your doctor will do the following:

• Your medical history will be reviewed.
• Ask about your family's health history.
• They will ask questions about your general health, eating habits, exercise habits, and symptoms.
• They ask about the medications you take (both those prescribed by your doctor and those you buy from the pharmacy).
• They ask if you smoke or use other drugs.
• They will listen to your heart and check your heartbeat.
• Check for signs of a heart attack (e.g., swelling in the legs and ankles).

Your cardiologist may also refer you to an electrophysiologist (a specialist in the electrical activity of the heart).

What kind of tests will be done?

To accurately diagnose this condition, you can do the following tests:

• Blood tests
• Genetic tests
• Electrocardiogram (EKG)
• Ambulatory monitor (a small device that records your heart rate over several days)
• Loop recorder (a device that monitors heartbeats for a long time)
• Electrophysiology study (a special method that examines the heart's electrical system)
• Exercise stress test (`Exercise stress test` - looking at how the heart works during exercise)

How is it treated?

The treatment for heart block varies from person to person. You may be hospitalized to monitor your heart. To manage your condition, your cardiologist will consider the following:

• What type of heart block do you have?
• How serious is it?
• How does it affect the functioning of your heart?
• What are your symptoms?

Sometimes, heart block goes away when you change the medications you take or treat another heart condition. But others may need a pacemaker, either temporarily or permanently, to send electrical signals to the heart.

• First-degree obstruction: You most likely won't need treatment.
• Second-degree blockage: If you have Type I, you probably won't need treatment. But if you have symptoms, you may need a temporary or permanent pacemaker to keep your heart beating properly.
• Third-degree blockage: People with this type almost always need a pacemaker.

If you need a pacemaker, your doctor will tell you about it, the type that is best for you, and what to expect before, during, and after the pacemaker is inserted.

What are the complications/side effects of the treatment?

If you have a temporary or permanent pacemaker, you may experience side effects such as:

• Problems with device programming
• Equipment malfunctions
• Infection
• Blood clots
• Heart damage

How long does it take to recover from this treatment?

After having a pacemaker, you will need to stay in the hospital for about one night. You should be able to resume your normal activities within a few days or weeks. Ask your doctor about what not to do after surgery.

Can heart attacks be prevented?

You can prevent some of the causes of heart failure, such as heart disease.

Things you can do to keep your heart and body as healthy as possible:

• Live a heart-healthy lifestyle. That means eating heart-healthy foods, getting regular exercise, getting enough sleep every night, reducing stress, limiting alcohol, and avoiding smoking and drug use.
• Talk to your doctor about the medications and supplements you take. He or she can check to see if anything you're taking is changing the normal levels of certain substances in your body (such as potassium, calcium, and magnesium, which are important for the heart's electrical system). Your doctor can adjust your medications if necessary.

What happens if I have a heart block?

If you have first-degree heart block, ask your cardiologist or electrophysiologist if you need to make any changes to your lifestyle or medications. This type of heart block often doesn't interfere with your normal activities.

Usually, having a pacemaker does not significantly limit your ability to participate in sports and hobbies. However, it is very important to follow your doctor's instructions to make sure your pacemaker is working properly.

How long does heart block last?

How long your heart block will last depends on the cause. Replacing the medication that is causing the heart block with another medication may resolve the problem. But if the heart block is caused by something else, it is likely to be a lifelong condition.

What is the outlook for heart block?

Heart block is a potentially serious condition. If left untreated, a severe heart block can lead to sudden cardiac arrest. But more commonly, untreated heart block can cause dizziness or fainting.

With treatment, your situation depends on your age and other medical conditions you have.

How should I take care of myself? (Especially if you have a pacemaker)

If you have a pacemaker, remember these things:

• Stay away from magnetic devices and any device that emits an electric field. This means staying at least 6 inches away from cell phones. For example, don't keep your cell phone in your shirt pocket.
• When going through security checkpoints (e.g. airports, courts), tell the screeners that you have a pacemaker and should avoid handheld wands. Always carry a card with you stating your pacemaker type.
• Tell all your healthcare providers (doctors, dentists) that you have a pacemaker. Some medical procedures, such as magnetic resonance imaging (MRI) tests, can interfere with your pacemaker. After some types of surgery, your doctor may need to reprogram your pacemaker.

When do you need to see a doctor?

If you have a pacemaker, your cardiologist will check it periodically to make sure it continues to work well. They can monitor you remotely, but you will still need annual in-person visits where your doctor can check your pacemaker and make any necessary adjustments.

Call your doctor if you experience any of these symptoms:

• Dizziness or fainting
• Chest pain
• Heart palpitations or skipping beats
• Weakness
• Difficulty breathing
• Swelling of the feet, ankles, or legs

When do you need to go to the Emergency Treatment Unit (ETU) ?

If you are having a heart attack or cardiac arrest, you need immediate medical attention. Make your family and workmates aware of this risk (and the symptoms). They can then call 1990 (or your local emergency number).

What questions should I ask the doctor?

Some questions you can ask your doctor:

• What type of heart block do I have?
• Do I need treatment?
• What is the best treatment for me?
• If my child has congenital heart disease, can my future children also have it?

It's normal to feel scared when you have chest pain or trouble breathing. But when you're diagnosed with a heart block, you can understand why you're having those symptoms. The good news is that for those who need treatment, medication or a pacemaker can help keep your heart beating normally. When discussing your treatment plan, be sure to ask your doctor about anything that's unclear.

Finally, things to remember (Take-Home Message)

Heart block is a problem with the heart's electrical system. It can range from mild to severe. If you develop symptoms, especially chest pain, shortness of breath, or fainting, see a doctor right away.

Fortunately, there are treatments for this. Some people find relief with a change in medication, while others can live a normal life with a pacemaker. The most important thing is to take care of your heart, follow your doctor's instructions, and ask your doctor if you have any questions. You are not alone, and there are doctors who can help you on this journey.

` Heart Block, Heartbeat, Pacemaker, Heart Symptoms, Heart Disease, Heart Health