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Second opinion for HP Block
Blood
Report in 240Hrs
At Home
No Fasting Required
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Review of histopathology.
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Second Opinion for HP Block - Comprehensive Medical Test Guide
- Why is it done?
- Verification of Heart Block Diagnosis: To confirm the presence of a second-degree atrioventricular (AV) block, specifically Mobitz Type II or other HP (His-Purkinje) system conduction abnormalities that may have been identified on initial diagnostic evaluation.
- Assessment of Conduction System Disease: To evaluate the severity and location of conduction abnormalities within the His-Purkinje system, which carries electrical signals from the AV node to the ventricles.
- Determination of Pacemaker Necessity: To establish whether permanent pacemaker implantation is indicated based on the clinical significance and symptomatic nature of the HP block.
- Clarification of Discrepant Results: When initial test results are unclear, equivocal, or contradictory to clinical symptoms, requiring further diagnostic confirmation.
- Monitoring Disease Progression: To assess any deterioration or progression of conduction abnormalities in patients with previously documented HP block.
- Evaluation of Medication Effects: To determine if antiarrhythmic drugs or other medications have influenced the degree of conduction block.
- Normal Range
- ECG Intervals (Normal Values): • PR Interval: 120-200 milliseconds (0.12-0.20 seconds) • QRS Duration: Less than 120 milliseconds (0.12 seconds) • AV Conduction: 1:1 with each atrial impulse conducted to the ventricles
- Electrophysiology Study (EPS) Parameters: • His-Ventricular (HV) Interval: 35-55 milliseconds • AH Interval: 50-120 milliseconds • Wenckebach Cycle Length: >300 milliseconds
- Negative/Normal Result Interpretation: • No evidence of HP block or second-degree AV block • Normal conduction throughout the cardiac electrical system • All impulses are conducted normally from atria to ventricles
- Abnormal/Positive Result Interpretation: • Presence of HP block with prolonged HV interval (>55 ms) • Evidence of conduction delay or block within the His-Purkinje system • Intermittent or fixed conduction abnormalities
- Interpretation
- Mobitz Type II Second-Degree AV Block: • Characterized by sudden failure to conduct an atrial impulse without preceding PR prolongation • Indicates disease in the His-Purkinje system • More serious than Mobitz Type I due to risk of progression to complete heart block • Often requires pacemaker insertion
- Prolonged HV Interval (>55 ms): • Indicates slow conduction through the His-Purkinje system • May suggest infra-Hisian conduction disease • Carries increased risk of sudden high-degree AV block • Clinical decision for pacing depends on symptoms and degree of prolongation
- Complete Heart Block (Third-Degree AV Block): • No atrial impulses conduct to the ventricles • Requires immediate pacemaker implantation • Results in independent atrial and ventricular rhythms • May cause syncope, hypotension, and cardiac compromise
- Intermittent Conduction Block: • Block occurs sporadically or with specific triggers (exercise, medication) • Requires evaluation for underlying cause • May necessitate continuous monitoring or event recording
- Factors Affecting Interpretation: • Heart rate variability • Medication effects (beta-blockers, calcium channel blockers, antiarrhythmics) • Electrolyte abnormalities • Ischemia or infarction • Age-related degeneration of conduction system • Infiltrative or inflammatory cardiac disease • Vagal stimulation levels
- Associated Organs
- Primary Organ Involved: • Heart (specifically the conduction system: sinoatrial node, AV node, and His-Purkinje network)
- Associated Medical Conditions: • Coronary artery disease and acute myocardial infarction • Cardiomyopathy (dilated, restrictive, or hypertrophic) • Myocarditis and pericarditis • Heart failure • Lyme disease (Lyme borreliosis) • Rheumatic heart disease • Infiltrative diseases (sarcoidosis, amyloidosis, hemochromatosis) • Chagas disease • Degenerative conduction system disease • Fibrosis or calcification of conduction pathways
- Complications Associated with Abnormal Results: • Syncope or presyncope episodes • Sudden cardiac death • Progression to complete heart block • Hemodynamic compromise and cardiogenic shock • Cerebrovascular accidents from inadequate cerebral perfusion • Falls and trauma secondary to syncope • Reduced exercise tolerance and functional limitation • Development of atrial fibrillation
- Secondary Organ Effects: • Brain: Hypoxia from reduced cardiac output • Kidneys: Decreased perfusion leading to renal dysfunction • Lungs: Pulmonary edema if cardiogenic shock develops • Liver: Congestion and dysfunction from reduced perfusion
- Follow-up Tests
- Recommended Follow-up Investigations: • Continuous Ambulatory ECG Monitoring (Holter Monitor): 24-48 hours to identify frequency and patterns of conduction block • Event Monitor Recording: For longer-term monitoring (weeks to months) to capture paroxysmal events • Stress Testing: To assess if conduction block worsens with exercise or resolves • Transthoracic Echocardiography: To evaluate cardiac structure, function, and assess for underlying cardiomyopathy
- Advanced Diagnostic Tests: • Cardiac MRI: To identify infiltrative disease, myocarditis, or cardiomyopathy • Cardiac CT: To assess coronary artery disease or structural abnormalities • Chest X-ray: To evaluate cardiac size and identify pulmonary congestion • Blood Tests: Troponin, BNP, electrolytes (potassium, magnesium, calcium), thyroid function
- Serologic Testing (if indicated): • Lyme serology (if suspected Lyme carditis) • ANA and complement levels (for systemic autoimmune disease) • ACE level (for sarcoidosis) • Troponin and inflammatory markers for myocarditis
- Monitoring Frequency: • Symptomatic HP Block: Regular follow-up every 3-6 months or more frequently if symptoms progress • Asymptomatic Prolonged HV Interval: Annual surveillance with ECG and clinical assessment • Post-Pacemaker Implantation: Device interrogation every 3 months, clinical evaluation every 6 months • Progressive Conduction Disease: More frequent monitoring as indicated by clinical deterioration
- Complementary Tests: • Repeat Electrophysiology Study: If initial results are inconclusive or after 1-2 years if pacing was deferred • Implantable Loop Recorder: For long-term monitoring in select patients • Pharmacologic Stress Testing: To evaluate conduction response to medications
- Fasting Required?
- Fasting Status: NO fasting is required for the ECG or standard second opinion evaluation.
- Test-Specific Preparation: • Remove all jewelry and metal objects from chest, neck, and wrists • Wear loose, comfortable clothing that can be easily opened for electrode placement • Avoid applying lotion, oils, or powder to the chest area on the day of testing • Arrive 10-15 minutes early to allow time for preparation • Avoid caffeine and stimulants for at least 24 hours before the test (if possible), as these may increase heart rate • Avoid smoking before the test, as nicotine can affect heart rate and rhythm
- Medication Considerations: • Continue regularly scheduled medications UNLESS specifically instructed otherwise by your physician • Inform the testing personnel of all medications being taken, especially: ◦ Beta-blockers (may lower heart rate) ◦ Calcium channel blockers (may delay conduction) ◦ Antiarrhythmic drugs ◦ Digoxin ◦ Tricyclic antidepressants • If an Electrophysiology Study is planned, specific medication adjustments may be required 3-5 days before the procedure (consult with your cardiologist)
- Additional Patient Preparation: • Avoid strenuous exercise or exertion for 24 hours before the test • Get adequate rest the night before testing • If stress testing is planned, wear comfortable, non-restrictive clothing and appropriate athletic shoes • For ECG: Allow approximately 15 minutes for electrode placement and recording • For Holter Monitor: No special preparation needed; device will be applied during office visit • For Electrophysiology Study: NPO (nothing by mouth) for 6-8 hours; arrange transportation home as sedation may be used
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