Most cases occur in patients over 60 years and is idiopathic, with an excellent long-term prognosis, provided a permanent pacemaker is implanted. Acute, reversible AV block commonly complicates inferior myocardial infarction. The condition may also be induced by metabolic and electrolyte disturbances, as well as by certain medicines.
Non-Pharmacological Treatment
- Emergency cardio-pulmonary resuscitation.
- External pacemaker should be available in all secondary hospitals and must be preceded by appropriate analgesia.
Pharmacological Treatment
Analgesia if external pacemaker:
C: Morphine 10–15 mg IM 3–6 hourly
AV nodal block with narrow QRS complex escape rhythm only:
A: Atropine, I.V bolus, 0.6–1.2 mg, may be repeated until a temporary or permanent pacemaker is inserted. Use in a patient with inferior myocardial infarct and hypotension and second-degree AV block.
It is temporary treatment of complete AV block before referral (urgently) for pacemaker.
OR
For resuscitation of asystole:
A: Adrenaline 1:10 000, slow IV, 5 mL (0.5 mg)
Used as temporary treatment of complete heart block when other drugs are not effective
Referral
All cases with a heart rate below 40 beats/minute after resuscitation and stabilization to high level of care where permanent pacemaker implantation can be performed
- All cases of second or third-degree AV block, whether myocardial infarct or other reversible cause is suspected, and whether the patient is thought to be symptomatic
- Permanent pacemaker is the definitive form of treatment.
Note: Complete Heart Block Is a Medical Emergency Refer Urgently
