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Sabzwari SRA, Tzou WS. Systemic Diseases and Heart Block. Rheum Dis Clin North Am 2024; 50:381-408. [PMID: 38942576 DOI: 10.1016/j.rdc.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Systemic diseases can cause heart block owing to the involvement of the myocardium and thereby the conduction system. Younger patients (<60) with heart block should be evaluated for an underlying systemic disease. These disorders are classified into infiltrative, rheumatologic, endocrine, and hereditary neuromuscular degenerative diseases. Cardiac amyloidosis owing to amyloid fibrils and cardiac sarcoidosis owing to noncaseating granulomas can infiltrate the conduction system leading to heart block. Accelerated atherosclerosis, vasculitis, myocarditis, and interstitial inflammation contribute to heart block in rheumatologic disorders. Myotonic, Becker, and Duchenne muscular dystrophies are neuromuscular diseases involving the myocardium skeletal muscles and can cause heart block.
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Affiliation(s)
- Syed Rafay A Sabzwari
- University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Mail Stop B130, Aurora, CO 80045, USA
| | - Wendy S Tzou
- Cardiac Electrophysiology, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, MS B-136, Aurora, CO 80045, USA.
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Sabzwari SRA, Tzou WS. Systemic Diseases and Heart Block. Cardiol Clin 2023; 41:429-448. [PMID: 37321693 DOI: 10.1016/j.ccl.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Systemic diseases can cause heart block owing to the involvement of the myocardium and thereby the conduction system. Younger patients (<60) with heart block should be evaluated for an underlying systemic disease. These disorders are classified into infiltrative, rheumatologic, endocrine, and hereditary neuromuscular degenerative diseases. Cardiac amyloidosis owing to amyloid fibrils and cardiac sarcoidosis owing to noncaseating granulomas can infiltrate the conduction system leading to heart block. Accelerated atherosclerosis, vasculitis, myocarditis, and interstitial inflammation contribute to heart block in rheumatologic disorders. Myotonic, Becker, and Duchenne muscular dystrophies are neuromuscular diseases involving the myocardium skeletal muscles and can cause heart block.
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Affiliation(s)
- Syed Rafay A Sabzwari
- University of Colorado Anschutz Medical Campus, 12631 East 17th Avenue, Mail Stop B130, Aurora, CO 80045, USA
| | - Wendy S Tzou
- Cardiac Electrophysiology, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, MS B-136, Aurora, CO 80045, USA.
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Abstract
Systemic diseases can cause heart block owing to the involvement of the myocardium and thereby the conduction system. Younger patients (<60) with heart block should be evaluated for an underlying systemic disease. These disorders are classified into infiltrative, rheumatologic, endocrine, and hereditary neuromuscular degenerative diseases. Cardiac amyloidosis owing to amyloid fibrils and cardiac sarcoidosis owing to noncaseating granulomas can infiltrate the conduction system leading to heart block. Accelerated atherosclerosis, vasculitis, myocarditis, and interstitial inflammation contribute to heart block in rheumatologic disorders. Myotonic, Becker, and Duchenne muscular dystrophies are neuromuscular diseases involving the myocardium skeletal muscles and can cause heart block.
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Gorenek B, Boriani G, Dan GA, Fauchier L, Fenelon G, Huang H, Kudaiberdieva G, Lip GYH, Mahajan R, Potpara T, Ramirez JD, Vos MA, Marin F, Blomstrom-Lundqvist C, Rinaldi A, Bongiorni MG, Sciaraffia E, Nielsen JC, Lewalter T, Zhang S, Gutiérrez O, Fuenmayor A. European Heart Rhythm Association (EHRA) position paper on arrhythmia management and device therapies in endocrine disorders, endorsed by Asia Pacific Heart Rhythm Society (APHRS) and Latin American Heart Rhythm Society (LAHRS). Europace 2018; 20:895-896. [DOI: 10.1093/europace/euy051] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/25/2018] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gheorge-Andrei Dan
- University of Medicine and Pharmacy “Carol Davila”, Colentina University Hospital, Bucharest, Romania
| | - Laurent Fauchier
- Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | | | - He Huang
- Renmin Hospital of Wuhan University, Wuhan, China
| | | | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rajiv Mahajan
- The University of Adelaide, Lyell McEwin Hospital, Royal Adelaide Hospital and SAHMRI, Adelaide, Australia
| | - Tatjana Potpara
- School of Medicine, Belgrade University; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | | | | | | | | | | | | | | | | | - Shu Zhang
- Beijing Fuwai Hospital, Beijing, China
| | | | - Abdel Fuenmayor
- Electrophysiology and Arrhythmia Section, Cardiovascular Research Institute, University Hospital of The Andes, Avenida 16 de Septiembre, Mérida 5101, Venezuela
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Seol SH, Kim DI, Park BM, Kim DK, Song PS, Kim KH, Jin HY, Seo JS, Jang JS, Yang TH, Kim DK, Kim DS. Complete Atrioventricular Block Presenting With Syncope Caused by Severe Hypothyroidism. Cardiol Res 2012; 3:239-241. [PMID: 28348695 PMCID: PMC5358139 DOI: 10.4021/cr221w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2012] [Indexed: 11/28/2022] Open
Abstract
A 75-year-old man was admitted to our hospital with syncope. Electrocardiogram showed complete atrioventricular block and bradycardia with the minimum heart rate of 22 beats/ min. There was a possible indication for temporary cardiac pacemaker implantation. Laboratory data on admission revealed high TSH level with low free T4 level. To rule out functional atrioventricular block, we treated several days with thyroxine. A follow-up electrocardiogram showed improved heart rate without any atrioventricular block. We found that severe hypothyroidism caused a complete atrioventricular block with syncope, and thyroxine replacement completely improved these conditions.
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Affiliation(s)
- Sang-Hoon Seol
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Doo-Il Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Bo-Min Park
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Dong-Kie Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Pil-Sang Song
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Ki-Hun Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Han-Young Jin
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Jae-Sik Jang
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Tae-Hyun Yang
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Dae-Kyeong Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Dong-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
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Alcalde-Rodríguez Ó, Rodríguez-Font E, Guerra-Ramos JM, Viñolas-Prat X. Bloqueo auriculoventricular infrahisiano secundario a radioterapia. Rev Esp Cardiol (Engl Ed) 2008; 61:1100-1. [DOI: 10.1157/13126052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Schoenmakers N, de Graaff W, Peters R. Hypothyroidism as the cause of atrioventricular block in an elderly patient. Neth Heart J 2008; 16:57-9. [PMID: 18335023 PMCID: PMC2245813 DOI: 10.1007/bf03086119] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Syncope is a common problem in the older patient. Sometimes syncope is caused by extreme bradycardia secondary to atrioventricular (AV) block. We describe a case in which a 90-year-old woman presented with complete AV block due to severe hypothyroidism. After suppletion with levothyroxine, AV conduction was restored. (Neth Heart J 2008;16:57-9.).
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Affiliation(s)
- N. Schoenmakers
- Department of Cardiology, Department of Internal Medicine, Tergooi Hospital Blaricum, the Netherlands
| | - W.E. de Graaff
- Department of Internal Medicine, Tergooi Hospital Blaricum, the Netherlands
| | - R.H.J. Peters
- Department of Cardiology, Tergooi Hospital Blaricum, the Netherlands
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LEE JK, LEWIS JA. Myxoedema with complete A-V block and Adams-Stokes disease abolished with thyroid medication. BRITISH HEART JOURNAL 1998; 24:253-6. [PMID: 14463513 PMCID: PMC1017878 DOI: 10.1136/hrt.24.2.253] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mangiardi L, Gaita F, Brun S, Presbitero P, Nademanee K, Singh BN. Atrioventricular block complicating amiodarone-induced hypothyroidism in a patient with pre-excitation and rate-dependent bilateral bundle branch block. J Am Coll Cardiol 1986; 7:180-4. [PMID: 3941210 DOI: 10.1016/s0735-1097(86)80279-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
As a clinical entity atrioventricular (AV) block due to hypothyroidism is rare. Such a case induced by hypothyroidism complicating long-term therapy with amiodarone in a 45 year old woman with pre-excitation is presented. Electrophysiologic data obtained before and during thyroxine replacement therapy showed that hypothyroidism lengthens the effective refractory period of the atria, AV node, bypass tract and His-Purkinje system (that in the ventricle not being measured); this lengthening resembles the effects of long-term administration of amiodarone. These observations suggest that depressed thyroid function may be protective against arrhythmias but a patient with preexisting conduction system disease may develop AV block. The tendency to develop AV block in a patient who is euthyroid was reduced by bypass tract conduction. These findings are significant not only in monitoring amiodarone effects during chronic prophylactic drug therapy but also in providing further insight into the complex interrelation between the action of the drug and the thyroid hormones on cardiac muscle.
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Paine TD, Rogers WJ, Baxley WA, Russell RO. Coronary arterial surgery in patients with incapacitating angina pectoris and myxedema. Am J Cardiol 1977; 40:226-31. [PMID: 879030 DOI: 10.1016/0002-9149(77)90012-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Singh JB, Starobin OE, Guerrant RL, Manders EK. Reversible atrioventricular block in myxedema. Chest 1973; 63:582-5. [PMID: 4695358 DOI: 10.1378/chest.63.4.582] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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Weir RJ, Young JA, McGuinness JB. Changes in the electrocardiogram and achilles reflex test during treatment of hypothyroidism. Scott Med J 1969; 14:59-63. [PMID: 5767386 DOI: 10.1177/003693306901400206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
In 10 patients with hypothyroidism, the electrocardiogram and Achilles reflex test have been recorded before and during treatment with l-thyroxine sodium. Aspects of the electrocardiogram affected by hypothyroidism are the rate, duration of PR interval, height of P-wave, of QRS complex and of T-wave and the ST segment. Each of these improved with therapy, the earliest and most sensitive change being the height of the QRS complex. The Achilles reflex time as recorded by the photomotograph also showed a parallel decrease with therapy but this is considered to be less reliable as an isolated test. The prolongation of the PR interval is briefly discussed and a correlation between the changes in skeletal and myocardial muscle is suggested.
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