माझा हार्ट ब्लॉक!

माझा २ एव्ही हार्ट ब्लॉक आणि श्री स्वामी समर्थांचा संदेश!

#स्वामी सांगतात,ʻʻमित्रांनो,तुमच्या म्हातारपणाची व्याख्या करू नका. जो शरीराने ॲक्टीव्ह, चटपट्या, चपळ आणि कामसु असतो तो मनाने सदैव तरूणच असतो. उर्वरीत आयुष्यात लाचारी पत्करण्यापेक्षा जमेल तेवढं स्वत:ला ॲक्टीव्ह ठेवा वाटलीच भीती, तर माझं नाव घे. भिऊ नकोस, मी तुझ्या पाठीशी आहे...!

*⚜️💛।।श्री स्वामी समर्थ।।*🌸🙏🏻

(हा स्वामी संदेश माझा कोल्हापूरचा भाचा रविंद्र मोहिते याने दिनांक  ५.३.२०२५ रोजी मला एस.एम.एस. करून पाठवला)

माझे परमेश्वर व स्वामी समर्थांना सांगणेः

स्वामी, माझे म्हातारपण वेगळे आहे. आपण सगळ्यांना सारखाच आध्यात्मिक संदेश देता " भिऊ नकोस मी तुझ्या पाठीशी आहे"! पण स्वामी, प्रत्येकाचे शारीरिक, आर्थिक, सामाजिक, मानसिक प्रश्न वेगळे असतात. त्यामुळे तुमचा वरील एकच आध्यात्मिक संदेश सगळ्यांना समान कसा बरे लागू पडू  शकेल?

मी आताच जवळच्या डॉक्टरांना भेटून आलो. त्यांनी माझ्या हृदयाचे आक्रसून (आकुंचन होत) रक्ताला हृदयाबाहेर काढणारे म्हणजे पंपीग करणारे दोन कप्पे (व्हेंट्रिकल्स) मोठे (एनलॉर्ज) झाल्याने माझ्या हृदयाची विद्युतप्रवाही आकुंचन क्रिया २ एव्ही ब्लॉकने बिघडली आहे व पेसमेकर यंत्र त्या कप्प्यांना (व्हेंट्रिकल्स) आतून कृत्रिम विद्युत प्रवाही चाबूक मारून त्या कृत्रिम बळाने हृदयाची आकुंचन क्रिया सुधारण्याचे काम करील व माझा २ एव्ही ब्लॉक नियंत्रणात ठेवील असे सांगितले (permanent pacemaker implantation). पण मी जेव्हा डॉक्टरांना सांगितले की ६८ वयातील म्हाताऱ्या शरीरात (छातीत) मी पेसमेकर नावाचे ते विद्युत प्रवाही कृत्रिम यंत्र बिलकुल बसवणार नाही. त्यामुळे २ एव्ही हार्ट ब्लॉकचे रूपांतर ३ एव्ही ब्लॉक (कंम्प्लिट ब्लॉक) मध्ये होऊन हार्ट अटॕक येऊन मी मरेन एवढेच ना. मग मी तर अशा सहज नैसर्गिक मृत्यूचीच वाट बघत आहे. म्हातारपणी शरीर जर्जर होऊन अंथरूणावर खिचपत पडून मृत्यूची वाट बघत बसण्याऐवजी तो मृत्यू मला असा सहज पटकन आला तर किती बरे होईल. कारण मी माझ्या सर्व सांसारीक व व्यावसायिक जबाबदाऱ्या व्यवस्थित पार पाडल्या आहेत. मग आता आणखी कशाला जास्त जगायचे? आता जगण्याची इच्छाच उरली नाही. मग कशाला बसवू तो पेसमेकर माझ्या छातीत? हे ऐकून डॉक्टर म्हणाले "पेसमेकर शिवाय वृद्धापकाळातील राहिलेले आयुष्य जगण्याची व मृत्यूचा सहज स्वीकार करण्याची तुमची हिंमत दुर्मिळ आहे व तुम्ही मनाने जर एवढे मजबूत, खंबीर आहात तर मग परमेश्वरावर सर्व सोडून देऊन तुम्ही तुमच्या इच्छाशक्तीच्या जोरावर आणखी काही वर्षे जगूही शकता"! आता परमेश्वर व स्वामी समर्थ यांनी मला जास्त त्रास न देता लवकर सहज मृत्यू द्यावा, बस्स एवढीच प्रार्थना!

टीपः

माझ्या घराण्यात हृदयविकाराची पार्श्वभूमी आहे त्यामुळे माझा हृदय विकार अटळ आहे. ७९ वर्षे एवढे आयुष्य जगलेल्या माझ्या वडिलांना हृदयात विद्युत प्रवाह अडथळ्याच्या २ एव्ही ब्लॉकसह रक्तवाहिन्यांतील गुठळ्यांनी तयार केलेले हृदयातील ब्लॉकेजेसही होते. त्यांनाही हृदय शस्त्रक्रिया सांगितली होती. पण त्यांनी म्हातारपणी हृदय शस्त्रक्रिया करण्याऐवजी के.ई.एम. हॉस्पिटलने दिलेल्या कोलेस्ट्राल नियंत्रण व रक्त पातळ करणाऱ्या गोळ्या घेतच पुढील आयुष्य जगायचे खंबीरपणे ठरवले व ते ७९ वर्षे आयुष्य हळूहळू शारीरिक हालचाल करीत जगले. आणखी जास्त जगायची हौस कशाला हवीय माणसाला? माझ्या वडिलांचा मृत्यू हार्ट अटॕकनेच परळ, मुंबई येथील के.ई.एम. या मुंबई महानगरपालिकेच्या हॉस्पिटलमध्ये झाला.

(मीही कोलेस्ट्राल नियंत्रण करणारी
Rosuvastin 10 व रक्त पातळ करणारी Clopiros-AP या दोनच गोळ्या रक्तात गुठळ्या व हृदयात ब्लॉकेजेस होऊ नयेत म्हणून घेत आहे कारण २ एव्ही ब्लॉक बरोबर ब्लॉकेजेस म्हणजे दुष्काळात तेरावा महिना)

प्रसिद्ध हार्ट सर्जन डॉ. नितु मांडके यांनी त्यांच्या आयुष्यात कितीतरी हृदय शस्त्रक्रिया यशस्वीपणे पार पाडल्या पण ते स्वतःच हार्ट अटॕकने  गेले. यातून समजून घेणाऱ्याला मोठा संदेश मिळतो. मला तो संदेश मिळालाय व मी तो घेतलाय. इतरांचे मला माहित नाही.

-©ॲड.बी.एस.मोरे, ५.३.२०२५

गुगल माहितीः

ATRIOVENTRICULAR (AV)
BLOCK!

एट्रिओव्हेंट्रिक्युलरचा अर्थ हृदयाच्या कर्णिका आणि वेंट्रिकलच्या दरम्यान स्थित, संबंधित किंवा स्थित आहे.
एट्रिओव्हेंट्रिक्युलर नोड (एव्ही नोड) म्हणजे हृदयाच्या वरच्या भागामध्ये धडधडण्याचे समन्वय साधण्यासाठी हृदयाच्या ऍट्रिया आणि वेंट्रिकल्सला विद्युतरित्या जोडणारे नोड. हा हृदयाच्या विद्युत वहन प्रणालीचा भाग आहे. एट्रिओव्हेंट्रिक्युलर आणि ब्लॉक हे शब्द अनेकदा एकत्र वापरले जातात.

ATRIOVENTRICULAR BLOCK!

ATRIOVENTRICULAR चा अर्थ हृदयाच्या कर्णिका आणि वेंट्रिकलच्या दरम्यान स्थित, संबंधित किंवा स्थित आहे.

एट्रिओव्हेंट्रिक्युलर नोड किंवा एव्ही नोड हृदयाच्या वरच्या भागामध्ये धडधडण्याचे समन्वय साधण्यासाठी हृदयाच्या ऍट्रिया आणि वेंट्रिकल्सला विद्युतरित्या जोडते; हा हृदयाच्या विद्युत वहन प्रणालीचा भाग आहे. AV नोड हा कोरोनरी सायनसच्या उघडण्याच्या ...

एट्रिओव्हेंट्रिक्युलर नोड :

AV नोड हा कोरोनरी सायनसच्या उघडण्याच्या जवळ इंटरएट्रिअल सेप्टमच्या खालच्या मागच्या भागात असतो आणि ॲट्रियापासून वेंट्रिकल्सपर्यंत सामान्य विद्युत आवेग चालवतो. AV नोड अगदी संक्षिप्त आहे.

ATRIOVENTRICULAR BLOCK:

block. ... relating to the connection between the atrium (= upper space) of heart.

ATRIOVENTRICULAR:

Relating to the connection between the atrium (= upper space) and ventricle (= lower space) of heart.

हार्ट व्हॉल्व्ह दुरुस्ती किंवा बदलण्याची शस्त्रक्रियाः
हृदयाच्या झडपांची दुरुस्ती किंवा बदलण्याची शस्त्रक्रिया म्हणजे काय? हृदय हा स्नायूंच्या ऊतींनी बनलेला पंप आहे. यात 4 पंपिंग चेंबर्स आहेत: 2 वरच्या चेंबर्स, ज्याला एट्रिया म्हणतात आणि 2 खालच्या चेंबर्स, ज्याला वेंट्रिकल्स म्हणतात.

ventricular hypertrophy is a thickening of the wall of the heart's main pumping chamber, called the left ventricle.

2 AV HEART BLOCK!

A second-degree atrioventricular (AV) block can progress to a complete heart block, especially if it's a Mobitz type II block. This progression can be sudden and may increase the risk of death.

How it happens
In a second-degree AV block, some impulses from the atria don't reach the ventricles?

In a Mobitz type II AV block, the PR intervals are always the same length, but some P waves aren't conducted.
This block can progress to a complete heart block when the block worsens and more impulses are prevented from reaching the ventricles.

Treatment:

A pacemaker may be needed to keep the heart beating normally.

Patients with second-degree AV block may be asymptomatic or they may experience variety of symptoms such as lightheadedness and syncope. Mobitz type II AV block may progress to complete heart block, with an associated increased risk of mortality.

Which AV block is likely to convert to complete heart block?

What is the treatment for a 2nd degree AV block?

What happens when you go into complete heart block?

कोणता एव्ही ब्लॉक संपूर्ण हृदय ब्लॉकमध्ये रूपांतरित होण्याची शक्यता आहे?

Second-Degree Atrioventricular Block:

Type II blocks imply structural damage to the AV conduction system. This rhythm often deteriorates into complete heart block.

A Case of Alternating First-, Second-, and Third-Degree Heart Blocks:

It is not uncommon for the second-degree Mobitz II AV block to progress to complete heart block.

Atrioventricular (AV) Block:

Complete Heart Block is when electrical signals do not travel between the lower and upper chambers of our heart.

फर्स्ट-डिग्री हार्ट ब्लॉक: या प्रकारात, हृदयातील विद्युत सिग्नल AV नोडमधून नेहमीपेक्षा हळू हलतो, ज्यामुळे विलंब होतो. तथापि, सिग्नल अखेरीस खालच्या खोलीपर्यंत पोहोचतो, ज्यामुळे हार्ट ब्लॉकचा सर्वात सौम्य प्रकार बनतो.

थर्ड-डिग्री एट्रिओव्हेंट्रिक्युलर ब्लॉक ... थर्ड-डिग्री एव्ही ब्लॉक, किंवा पूर्ण हार्ट ब्लॉक, जेव्हा वेंट्रिकल्समध्ये ॲट्रिअल आवेग चालवले जात नाहीत तेव्हा उद्भवते. वेंट्रिकल्स त्यांच्या सुटकेची लय तयार करतात, जी सहसा मंद आणि अविश्वसनीय असते ...

Second-Degree Heart Block: Symptoms, Causes,  Second-degree heart block is a condition in which the impulses from the atria occasionally fail to reach the ventricles.

Mobitz type II is a type of 2nd degree AV block, which refers to an irregular cardiac rhythm (i.e., arrhythmia) caused by a block in heart.

2 AV HEART BLOCK!

Second-Degree Atrioventricular Block

Updated: Jun 28, 2022

Author: Ali A Sovari, MD, FACP, FACC; Chief Editor: Jeffrey N Rottman, MD

Second-degree atrioventricular (AV) block, or second-degree heart block, is a disease of the cardiac conduction system in which the conduction of atrial impulse through the AV node and/or His bundle is delayed or blocked. Patients with second-degree AV block may be asymptomatic or they may experience variety of symptoms such as lightheadedness and syncope. Mobitz type II AV block may progress to complete heart block, with an associated increased risk of mortality. Second degree AV block implies that some predictable set of impulses fails to traverse the connection from atrium to ventricle while other impulses do.

Signs and symptoms:

In patients with second-degree AV block, symptoms may vary substantially, as follows:

No symptoms (more common in patients with type I, such as well-trained athletes and persons without structural heart disease).

Light-headedness, dizziness, or syncope (more common in type II).

Chest pain, if the heart block is related to myocarditis or ischemia.

A regularly irregular heartbeat.

Bradycardia may be present.

Symptomatic patients may have signs of hypoperfusion, including hypotension.

Diagnosis:

Electrocardiography (ECG) is employed to identify the presence and type of second-degree AV block. The typical ECG findings in Mobitz I (Wenckebach) AV block—the most common form of second-degree AV block—are as follows:

Gradually progressive PR-interval prolongation occurs before the blocked sinus impulse.

The greatest PR increment typically occurs between the first and second beats of a cycle, gradually decreasing in subsequent beats.

Shortening of the PR interval occurs after the blocked sinus impulse, provided that the P wave is conducted to the ventricle.

Junctional escape beats may occur along with nonconducted P waves.

A pause occurs after the blocked P wave that is less than the sum of the 2 beats before the block.

During very long sequences (typically >6:5), PR-interval prolongation may be inapparent and minimal until the last beat of the cycle, when it abruptly becomes much greater.

Post-block PR-interval shortening remains the cornerstone of the diagnosis of Mobitz I block, regardless of whether the periodicity has typical or atypical features.

R-R intervals shorten as PR intervals become longer.

The typical ECG findings in Mobitz II AV block are as follows:

Consecutively conducted beats with the same PR interval are followed by a blocked sinus P wave.

PR interval in the first beat after the block is similar to the PR interval before the AV block.

A pause encompassing the blocked P wave is equal to exactly twice the sinus cycle length.

The level of the block, AV nodal or infranodal (ie, in the specialized His-Purkinje conduction system), carries prognostic significance, as follows:

AV nodal blocks, which are the vast majority of Mobitz I blocks, carry a favorable prognosis.

AV nodal blocks do not carry the risk of direct progression to a Mobitz II block or a complete heart block [1] ; however, if there is an underlying structural heart disease as the cause of the AV block, a more advanced AV block may manifest in the later stages of the disease.

Infranodal blocks carry significant risk of progression to complete heart block.

Evaluating for stability of the sinus rate is important because conditions associated with increases in vagal tone may cause simultaneous sinus slowing and AV block and, therefore, mimic a Mobitz II block. In addition, diagnosing Mobitz II block in the presence of a shortened post-block PR interval is impossible.

An invasive His bundle recording is required to make the diagnosis of an infranodal block; however, ECG indications regarding the site of the block are as follows:

A Mobitz I block with a narrow QRS complex is almost always located in the AV node.

A normal PR interval with minuscule increments in AV conduction delay should raise the suggestion of an infranodal Wenckebach block; however, larger increments in AV conduction do not necessarily exclude infranodal Wenckebach block.

In the presence of a wide QRS complex, AV block is more often infranodal.

An increment in PR interval of longer than 100 msec favors a block site in the AV node.

Diagnostic:

Electrophysiologic testing can help determine the level of the block and the potential need for a permanent pacemaker.

Such testing is indicated for patients in whom His-Purkinje (infranodal) block is suspected but has not been confirmed, such as those with the following:

Mobitz I second-degree AV block associated with a wide QRS complex in the absence of symptoms.

2:1 second-degree AV block with a wide QRS complex in the absence of symptoms.

Mobitz I second-degree block with a history of unexplained syncope.

Other indications for electrophysiologic testing are as follows:

Patients with pseudo-AV block and those with premature, concealed junctional depolarization, which may be the cause of second- or third-degree AV block.

Patients with second- or third-degree AV block in whom another arrhythmia is suspected as the cause of the symptoms (eg, those who remain symptomatic after pacemaker placement).

In most cases, however, further monitoring (either inpatient rhythm monitoring or ambulatory ECG monitoring) provides adequate diagnostic information such that, currently, it is rare to perform an electrophysiology study solely for the evaluation of conduction disease.

Laboratory studies to identify possible underlying causes are as follows:

Serum electrolytes, calcium, and magnesium levels.

A digoxin level in patients on digoxin.

Cardiac biomarker testing in patients with suspected myocardial ischemia.

Myocarditis-related laboratory studies (eg, Lyme titers, HIV serologies, enterovirus polymerase chain reaction [PCR], adenovirus PCR, Chagas titers), if clinically relevant.

Infection-related studies, apropos a valve ring abscess.

Thyroid function studies if appropriate.

Management
Acute treatment of Mobitz type I second-degree AV block is as follows:

In patients who have symptoms or who have concomitant acute myocardial ischemia or myocardial infarction (MI), admission is indicated to a unit with telemetry monitoring and transcutaneous pacing capabilities.

Symptomatic patients should be treated with atropine and transcutaneous pacing immediately, followed by transvenous temporary pacing until further workup determines the etiology of the disease.

Atropine should be administered with caution in patients with suspected myocardial ischemia, as ventricular dysrhythmias can occur. Atropine increases the conduction in the AV node. If the conduction block is infranodal (eg, if the block is Mobitz II), an increase in AV nodal conduction by atropine only worsens the infranodal conduction delay and increases the AV block.

Acute treatment of Mobitz type II second-degree AV block is as follows:

Admit all patients to a unit with monitored beds, where transcutaneous and transvenous pacing capabilities are available.

Apply transcutaneous pacing pads to all patients with Mobitz II second-degree AV block, including those who are asymptomatic, because of the risk of progression to complete heart block. Test the transcutaneous pacemaker to ensure capture; if capture cannot able be achieved, then insertion of a transvenous pacemaker is indicated, even in asymptomatic patients.

Urgent cardiology consultation is indicated for patients who are symptomatic or are asymptomatic but unable to achieve capture with transcutaneous pacing.

It is reasonable to insert a transvenous pacemaker for all new Mobitz type II blocks.

Hemodynamically unstable patients for whom an emergency cardiology consult is not available should undergo placement of a temporary transvenous pacing wire in the emergency department, with confirmation of correct positioning by chest radiography.

Guidelines recommend the following as indications for permanent pacing in second-degree AV block [2, 3] :

Second-degree AV block associated with signs such as bradycardia, heart failure, and asystole for 3 seconds or longer while the patient is awake.

Second-degree AV block with neuromuscular diseases, such as myotonic muscular dystrophy, Erb dystrophy, and peroneal muscular atrophy, even in asymptomatic patients (progression of the block is unpredictable in these patients); in some of these patients, an implantable cardioverter defibrillator (ICD) may be appropriate.

Mobitz II second-degree AV block with wide QRS complexes.

Asymptomatic Mobitz I second-degree AV block with the block at intra- or infra-His level found on electrophysiologic testing. Some of the electrophysiologic findings of an intra-His block include an HV interval longer than 100 msec, doubling of the HV interval after administration of procainamide, and the presence of split double potentials on the His recording catheter.

In some cases, the following may also be indications for permanent pacemaker insertion:

Persistent, symptomatic second-degree AV block after MI, especially if it is associated with bundle-branch block; AV block resulting from right coronary artery occlusion tends to resolve over a few days after revascularization versus left anterior descending artery MI, which results in permanent AV block.

High-grade AV block after anterior MI, even if transient.

Persistent second-degree AV block after cardiac surgery.

Permanent pacing may not be required in the following situations:

Transient or asymptomatic second-degree AV block after MI, particularly after right coronary artery occlusion.

Second-degree AV block in patients with drug toxicity, Lyme disease, or hypoxia in sleep.

Whenever correction of the underlying pathology is expected to resolve second-degree AV block.

AV block after transcatheter aortic valve implantation may occur. This is a relatively new technology, and there is not enough adequate evidence to guide the patient's therapies in this situation. In some cases, depending on the type of the implanted valve, baseline ECG features, degree and location of the aortic valve calcification, and the patient's comorbidities, implanting a permanent pacemaker outside of conventional criteria may be a reasonable and safe approach.

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Besides Mobitz I and II, other classifications used to describe forms of second-degree AV block are 2:1 AV block and high-grade AV block. By itself, a 2:1 AV block cannot be classified as either Mobitz I or Mobitz II. Both a 2:1 AV block and a block involving 2 or more consecutive sinus P waves are sometimes referred to as high-grade AV block. In high-grade AV block, some beats are conducted, in contrast to what is seen with third-degree AV block.

Etiology:

Cardioactive drugs are an important cause of AV block. They may exert negative (ie, dromotropic) effects on the AVN directly, indirectly via the autonomic nervous system, or both. Digoxin, beta-blockers, calcium channel blockers, and certain antiarrhythmic drugs have been implicated in second-degree AV block.

More recently, administration of the first dose of fingolimod, an immunosuppressant used to treat relapsing forms of multiple sclerosis, has been associated with second-degree AV block (Mobitz types I and II); these effects may persist for several days following fingolimod initiation.

The AV block may not resolve in many of the patients who take cardioactive medications. This suggests an underlying conduction disturbance in addition to the medications as the etiology of the AV block. At toxic levels, other pharmacologic agents, such as lithium, may be associated with AV block. Benzathine penicillin has been associated with second-degree AV block.

They did not observe any improvement in the AV block within the next 14 days, and most of these patients required permanent pacemaker implantation.

Genetic factors:

In some patients, AV block may be an autosomal dominant trait and a familial disease. Several mutations in the SCN5A gene have been linked to familial AV block.

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