Third-Degree Atrioventricular Block Differential Diagnoses

  • Author: Adam S Budzikowski, MD, PhD; Chief Editor: Jeffrey N Rottman, MD   more...
 
Updated: Sep 16, 2011
 
 

Diagnostic Considerations

Ischemia should always be in the differential for a patient with new-onset high-degree atrioventricular (AV) block. Take simple measures to rule out ischemia, such as 12-lead electrocardiography (ECG) and measurement of cardiac enzyme levels. If warranted, a more in-depth evaluation, including perfusion imaging, may be needed.

Iatrogenic heart block due to medications is not uncommon and should always be considered. Other problems to be considered include the following:

  • Bradycardia with a ventricular escape
  • Bradycardia with a junctional escape
  • Accelerated junctional escape rhythm

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Adam S Budzikowski, MD, PhD  Assistant Professor of Medicine, Division of Cardiovascular Medicine, Electrophysiology Section, State University of New York Downstate Medical Center, University Hospital of Brooklyn

Adam S Budzikowski, MD, PhD is a member of the following medical societies: European Society of Cardiology, Heart Rhythm Society, and Polish Society of Cardiology

Disclosure: Boston Scientific Consulting fee Consulting; St. Jude Medical Honoraria Speaking and teaching; Zoll Honoraria Speaking and teaching

Coauthor(s)

Andrew C Corsello, MD  Consulting Staff, Department of Internal Medicine, Division of Cardiology, Cardiovascular Consultants of Maine, PA

Disclosure: Nothing to disclose.

James P Daubert, MD  Professor of Medicine, Cardiology Division, Duke University School of Medicine

James P Daubert, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American Heart Association, and Heart Rhythm Society

Disclosure: Medtronic Equity interest None; Boston Scientific Honoraria Speaking and teaching; CV Therapeutics Consulting fee Consulting; Cryocor Consulting fee Consulting

Theodore J Gaeta, DO, MPH, FACEP  Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine

Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: Alliance for Clinical Education, American College of Emergency Physicians, Clerkship Directors in Emergency Medicine, Council of Emergency Medicine Residency Directors, New York Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Michael D Levine, MD  Physician, Department of Medical Toxicology, Banner Good Samaritan Medical Center; Physician, Department of Emergency Medicine, Banner Thunderbird Medical Center

Michael D Levine, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, Emergency Medicine Residents Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Abrar H Shah, MD  Clinical Assistant Professor, Department of Medicine, University of Rochester Medical Center; Consulting Staff, Department of Medicine (Cardiology), Strong Memorial Hospital, Geneva General Hospital; Consulting Staff, Department of Cardiology, Highland Hospital; Consulting Staff, Department of Cardiology and Electrophysiology, Park Ridge Hospital

Disclosure: Nothing to disclose.

Specialty Editor Board

Eddy S Lang, MDCM, CCFP(EM), CSPQ  Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Brian Olshansky, MD  Professor of Medicine, Department of Internal Medicine, University of Iowa College of Medicine

Brian Olshansky, MD is a member of the following medical societies: American Autonomic Society, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American College of Sports Medicine, American Federation for Clinical Research, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, and New York Academy of Sciences

Disclosure: Guidant/Boston Scientific Honoraria Speaking and teaching; Medtronic Honoraria Speaking and teaching; Guidant/Boston Scientific Consulting fee Consulting; Novartis Honoraria Speaking and teaching; Novartis Consulting fee Consulting

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD  Professor of Medicine and Pharmacology, Vanderbilt University School of Medicine; Chief, Department of Cardiology, Nashville Veterans Affairs Medical Center

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association and North American Society of Pacing and Electrophysiology (NASPE)

Disclosure: Nothing to disclose.

References

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  14. Syverud S. Cardiac pacing. Emerg Med Clin North Am. May 1988;6(2):197-215. [Medline].

 
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ECG before and after complete heart block at the AV nodal level.
Complete heart block with wide complex escape.
Electrocardiogram from patient in complete heart block.
 
 
 
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