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Symptoms and treatment for MOBITZ TYPE1 AV BLOCK.

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I have questions regarding the symptoms of AV block. I am a 31 year old man, and a year ago I was diagnosed with 2nd degree AV block, mobitz type 1. I had no symptoms at the time, I was seeing the doctor about a concern that turned out to be benign. However, a few months ago I started to feel a bit dizzy/heavy headed occasionally. It was never brought on by anything in particular that I could tell, and it was not severe, sometimes barely perceptible, but it was sustained, for hours or days. However, it has recently gotten worse. First just gradually worse, then about a week ago I got more severe dizziness than before. The dizziness currently lasts all day. Sometimes I don't notice it until I stand up and walk around. Sometimes it's not that bad, but I always feel a bit off. It's not so bad that I am going to fall over. And, I never have to stop what I'm doing to rest. It doesn't impact my daily life at all, but it's there and makes me feel lazy and lethargic. I haven't fainted, or even come close to fainting. I'm a little short of breath but nothing too severe.

I saw a cardiologist but he said I need to wait until I get the results of the 24-hour holter monitor test to know what's wrong. I've got to wait 3 weeks to get the test done. He checked my heart at the office, while I was experiencing dizziness, and said my heart seemed to be beating normally.

I am physically active, I exercise several times a week. I drink, sometimes too much and I am not a very healthy eater. So I am a bit overweight (6'2', 220lbs, 36-38 inch waist). If I get a hangover, I usually can't sleep the night after drinking because my heart is pounding. I also get heart pounding with indigestion. 24-holter determined this pounding was not a cause for concern.

My blood pressure is usually around 75-85/135-145. I sometimes deal with a bit of anxiety, nothing too severe. I have been checking my heart rate a lot in the last week/10 days and it is always at least 60 beats per minute at rest. (60-80).

My questions are about the symptoms of AV Block. Whether it tends to be sustained dizziness, occasional dizziness, what makes it worse? I can run, climb stairs quickly, walk quickly, and it doesn't make the dizziness any better or worse. The dizziness level I'm currently experiencing is always the same unless I'm sitting or laying down, and then I don't notice it that much. Is it possible my dizziness could be caused by something else? If I am experiencing AV block, is it possible for a doctor or nurse (or even me?) to be able to tell by listening to my heart or checking my pulse? I was under the impression that AV block meant skipped beats and/or slow heart rate, and that is what causes the dizziness. Is this true?

I would also like some advice on what questions to ask my cardiologist, on what to ask for in terms of tests and treatment.

Thank you

Category: Cardiologist

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Dr. Vivek Mahajan
Category: Cardiologist
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Expert:  Dr. Vivek Mahajan
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Hello,
Thank you for choosing DoctorSpring.
I understand your concern and I will try my best to help you here.
AV blocks (Type 1 and 2 ) can occur without any symptoms in most cases. But in certain individuals AV blocks can present itself with the symptoms such as dizziness or tiredness as in your case. When the block is present through out the hear beat it can be continuos dizziness like in your case. But when the block is occasional patinet can get occasional symptoms too. So essentially analysing the symptom and its pattern will not give much clue ( it could be yes or no).
What you Doctor suggested is the best next step - 24 hour Holter monitoring.
Since you have this dizziness, a little shortness of breath and previous history of hear block a complete evaluation is warranted. There is nothing much to worry though as you are not in any grave danger and heartblocks (if present) can be treated successfully.
To answer your other questions, yes you/your Doctor might be able to appreciate the heart block or skipped beat by checking the pulse or by an EKG. However the hear block might be present only during certain time intervals so it might not reflected in the pulse always. (You / Doctors can miss it and that's why continuous 24 hour monitoring is required for a Diagnosis) . This dizziness can be due to other causes including stress or anxiety. But in view of your previous history of heart block it is better to rule out that first. If heart blocks are ruled out you should get some basic tests done to rule out other causes of dizziness.
Do keep me posted, I will follow this up
Feel free to ask followups
Regards


Patient replied :

Thank you, Dr Vivek.
Some followup question:
1. It is likely for Mobitz Type 1 to progress to Mobitz Type 2? (Is type 2 often preceeded by type 1?)
2. What are the treatments for someone with 2nd degree AV block and type 1 mobitz? If I am having symptoms, is the only solution to remedy them a pacemaker? Are there medicines that can be perscribed, and would they have to be taken indefinitely?
3. My symptoms are due to heart block, are there things that will make the symptoms worse or better?


Expert:  Dr. Vivek Mahajan
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Hello,
Thank you for the follow up.
To answer your queries one by one :
1) Mobitz type I is the less evere form, and does not always progress to type II. It can happen but it is not common.
2) For 2nd degree AV Block ( TYPE I Mobitz ) - pacemaker is the permanent remedy. However even Trans cutaneous pacing ( TCP ) where through the skin impulses are sent to stabilise the heart is quite effective in Mobitz Type I.
3) Some aggravating factors such as stress/ anxiety can lead to the dizziness you're experiencing. So without investigations it will be difficult to attribute it directly to heart block. But factors such as electrolyte disturbances, hypertension, intake of medicines such as digoxin. In fact in a lot of trained athletes, some amount of Mobitz Type I is a common finding, which is vagally mediated.
Regards.


Patient replied :

Hello,
Thank you for the follow up.
To answer your queries one by one :
1) Mobitz type I is the less severe form, and does not always progress to type II. It can happen but it is not common.
2) For 2nd degree AV Block ( TYPE I Mobitz ) - pacemaker is the permanent remedy. However even Trans cutaneous pacing ( TCP ) where through the skin impulses are sent to stabilise the heart is quite effective in Mobitz Type I.
3) Some aggravating factors such as stress/ anxiety can lead to the dizziness you're experiencing. So without investigations it will be difficult to attribute it directly to heart block. But factors such as electrolyte disturbances, hypertension, intake of medicines such as digoxin. In fact in a lot of trained athletes, some amount of Mobitz Type I is a common finding, which is vagally mediated.
Regards.


Dr. Vivek Mahajan
Category: Cardiologist
Experience: 
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
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