Journal of Pharmaceutical Research International
33(46B): 546-550, 2021; Article no.JPRI.74283
ISSN: 2456-9119
(Past name: British Journal of Pharmaceutical Research, Past ISSN: 2231-2919,
NLM ID: 101631759)
A Case Report of Complete Heart Block
Sonal Dhobe1*, Seema Singh1, Ranjana Sharma1
and Ruchira Ankar1
1
Department of Medical Surgical Nursing, Smt. Radhikabai Meghe Memorial College of Nursing,
Datta Meghe Institute of Medical Sciences, (Deemed to be University), Sawangi (M) Wardha,
Maharashtra, India.
Authors’ contributions
This work was carried out in collaboration among all authors. All authors read and approved the final
manuscript.
Article Information
DOI: 10.9734/JPRI/2021/v33i46B32974
Editor(s):
(1) Dr. Win Myint Oo, SEGi University, Malaysia.
Reviewers:
(1) Jurandyr Santos Nogueira, Federal University of Bahia, Brazil.
(2) Walid Hammad, University Hospital Galway, Ireland.
Complete Peer review History: https://www.sdiarticle4.com/review-history/74283
Received 25 July 2021
Case Study Accepted 29 September 2021
Published 23 October 2021
ABSTRACT
Introduction: Complete Heart Block (CHB) occurs when the electrical signals can’t pass normally
from the atria, the heart’s upper chambers, to the ventricles or lower chambers. This condition can
develop because of congenital or secondary to cancers, myopathies or heart ischemia, infectious
or endocrinological disorders and it needs comprehensive work-up to be excluded.
Background: In the United States, the prevalence of third degree atrioventricular (AV) block that is
complete heart block is 0.02 percent. The prevalence of third-degree AV blocks worldwide is 0.04
percent. With advancing age, the rate of AV conduction defects rises, resembling the age-related
incidence of ischemic heart disease.
Case Presentation: A case of 68 year old female admitted in cardiac ward on date 11 january
2021 with the chief complaint of breathlessness on exertion, restlessness, chest pain and loss of
appetite since 2 month. The patient is a known case of hypertension since 5 year, Ischemic heart
disease sine 1 year. after physical examination and other investigation like ECG, electrocardiogram
the she diagnosed as a complete heart block with third degree.
Interventions: The patient was treated by placing permanent pacemaker on dated 18 january
2021. After that started the antibiotic like inj. targocid, inj. ceftriaxone, tab. linezolid, tab. orabest,
tab. telmed H and taking also the anticoagulant therapy. She also under the care of cardiologists
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Dhobe et al.; JPRI, 33(46B): 546-550, 2021; Article no.JPRI.74283
and monitor by hourly, also monitor the electric activity of pacemaker. Provide health education
about healthy diet, life style modification, yoga and exercised, control over blood pressure and
regular follow up.
Conclusion: This study mainly focusing on the medical and placement of permanent pacemaker
which help the heart to do their normal function and passing a normal electrical signals throught the
heart rhythm. A good nursing care needed for the patient who have complete heart block and
surgical implementation in permanent pacemaker for continue monitored, no any complication can
occur during or after pacemaker implantation. the patient response for the treatment was good and
she recover rapidly.
Keywords: Complete heart block; ischemic heart disease; hypertension.
1. INTRODUCTION wire mounted within the heart; this provides a
tiny electrical impulse to encourage the heart to
Complete Heart Block (CHB) occurs when the pump as it goes too sluggish [6].
electrical signals can't pass normally from the
atria, the heart's upper chambers, to the 2. CASE HISTORY
ventricles or lower chambers. The Complete
heart block (CHB) is known to be one of the risky 2.1 Patient Information
rhythms as fatal arrhythmias such as ventricular
tachycardia may advance. This condition can A case of 68 yearold female admitted in cardiac
develop because of congenital or secondary to ward on date 11 january 2021 with the chief
cancers, myopathies or heart ischemia, complaint of breathlessness on exertion,
infectious or endocrinological disorders and it restlessness, chest pain on radiating towards the
needs comprehensive work-up to be excluded back in left side and loss of appetite since 2
[1]. In the United States, the prevalence of third month. The patient is a known case of
degree atrioventricular (AV) block (complete hypertension since 5 year, Ischemic heart
heart block) is 0.02 percent. The prevalence of disease since1 year.
third-degree AV blocks worldwide is 0.04
percent. With advancing age, the rate of AV 2.2 Medical History
conduction defects rises, resembling the age-
related incidence of ischemic heart disease [2]. The patient had developed the problem of
Hypertrophic obstructive cardiomyopathy and hypertension before 5 year and she was continue
infiltrative myopathies including sarcoidosis and taking medication for hypertension is Tab. Telma
amyloidosis are thought to be alternative causes 40 mg on OD. Patient also develop Ischemic
of CHB as a secondary trigger [3]. Third-degree heart disease since 1 year. After investigation
heart block is generally referred to as absolute like ECG, blood test, Echo and angiography she
heart block that is complete heart block. The diagnosed as a complete heart block in third
diagnostic criteria include the occurrence of degree. Presently she showing the
atrioventricular (AV) which is full dissociation with breathlessness on exertion, restlessness and
a higher atrial rate as compared to ventricular chest pain. Patient was undergone the procedure
rate [4]. A typical clinical manifestation of full placement of permanent pacemaker on dated 18
heart block is chest pain and breathing difficult. A january 2021 after procedure patient not
unusual etiology of CHB that has not gained showing any complication and the device
adequate consideration is systemic sclerosis. It work properly as per patient ECG findings. No
remains inconclusive whether pacemaker any past surgical history and patient was
implantation is needed, especially when patients remains in the emergency room is presented
have no symptoms or mild CHB symptoms [5]. with previous medical records.
Some anti-arrhythmic medications modify the
electrical impulses in the heart and help
discourage erratic or fast heart beats from
2.3 Social History
beginning at abnormal locations. In order to treat
sluggish heart beats, all implantable machines or She maintain good interpersonal relationships
pacemakers function are used. A with family member, neighbors, friends and
little instruments inserted below the collarbone relatives. She believe in god and follow the
under the skin and attached by a vein to a speed religious beliefs.
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Dhobe et al.; JPRI, 33(46B): 546-550, 2021; Article no.JPRI.74283
2.4 Environmental History Eosinophils is 04% (1-5 %) and basophils is 00
% (0-1 %).
Patient home surround with good environment.
There is a facility of a closed drainage system 2.7 In Kidney Fuction Test (KFT)
and proper disposal of waste. proper ventilation
and all needy facilities available in her house. urea is 18.2 (9.81 – 20.1 mg/dl) , creatinine is 0.9
mg/dl (0.7-1.4 mg/dl ) ,sodium is 135meq/ l (135-
2.5 Physical Examination 145meq/l) , potassium 4.5(3.5-5.5 meq /l ).
2.5.1 General parameter 2.8 In liver Fuction Test (LFT)
Height: 150 cm, weight: 45 kg, body mass index alkaline phosphates is 40 (32-45g/l), Alanine
(BMI): 20 transaminase (ALT) is 44 IU/L (0-50IU/L),
0
Vital sign: temperature: 98 F, pulse: 68 beat / aspartate aminotransferase,( AST) is 35 IU/L
min, respiration: 16 breath/min, blood pressure: (10-40 IU/L) ,total protein ia 6.5 (23-38 g/dl) ,total
150/100mmof Hg, SpO2: 99%. bilirubin is 1.0 g/dl (1-1 g/dl ) ,conjugated bilirubin
is 0.2 mg/dl (0-0.25 mg/dl ) ,unconjugated
2.5.2 Mental status bilirubin is 0.8 mg/dl (0.2-0.7mg/dl) , globulin is
2.8.
She was conscious and aware about time place
and person. 2.9 In Electrocardiogram (ECG)
2.5.3 Pulmonary/cardiovascular An ECG may reveal abnormalities in heart
rhythm seen in the ECG before permanat
S1 and S2 sound is heard and normal heart pacemaker and after placement of permanat
sound is heard. Normal respiration and blood pacemaker the ECG shows normal findings.
pressure is high. No pleural effusion present.
3. ECHOCARDIOGRAPHY
2.5.4 Integumentary
3.1 Therapeutic Intervention
no any skin lesions and dry skin.
General measures: To check the vital sign
2.5.5 Musculoskeletal system (Temperature pulse respiration and BP ) and
airway. Continue observation and record
She was normal to walk, range of joint movement a heart's electrical function. Prevention of
is present. Active and passive movement is complications like infection, swelling, collapse
present. Periphery edema in lower extremities is lung and bruishing or bleeding at the generator
absent. site. Health management includes healthy diet,
lifestyle modification, regular activity and proper
2.5.6 Speech medication.
Speech is coherent. 3.2 In Pharmacological Management
2.6 Diagnosis Assessment 3.2.1 Antibiotics drugs
Blood investigation : In complete blood count Inj. Targocid 400mg is an antibiotic used in the
(CBC):Hemoglobin is 12.2 mg/dl(11-13mg/dl) , reatment of severe bacterial infection, it is
mean corpuscular hemoglobin concentration is effective to stopping the growth of bacteria. it is
32.6 g/dl , Mean corpuscular volume (MCV) is 90 narrow spectrum antibiotic that only covers the
fl (78-98 fl ), total RBC count is 4.52 m/ul, WBC gram positive type of bacteria. It gives OD
is 10200 (4500-11,500 k/ul) ,platelet count is intravenously.
239,000/ml (150,000 to 450,000 ),
Hematocrit (Hct) Levels is 35.7 % (37 %-47 %), Inj. Ceftriaxone – 1 gm IV. Ceftriaxone is the
monocytes is 04 %(00-15%) , Granulocytes is 74 third-generation antibiotic from the family of the
% and Lymphocytes is 30 %(20%-40%) , red antibiotic.
cell distribution width (RDW) is 12.9 (11.6-14.8) , Inj. Linzolid 600mg BD
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Dhobe et al.; JPRI, 33(46B): 546-550, 2021; Article no.JPRI.74283
3.2.2 Hypertensive drug 3.5 Therapeutic Diet Plan
Tab. Telma 40 mg is used to treat high blood Required the low sodium diet provides 2-3 gm
pressure and heart failure. lowering blood sodium 1600- 1800 calories which give adequate
pressure helps to prevent future heart attack and nutrition given. carbohydrate 200gm, protein
stroke. This medication is not given the patient 60gm and fat 40 gm.
with kidney and liver problem.
4. DISCUSSION
3.2.3 Antiemetic agent
Patients are those very young and it's not often a
Inj emeset 4 mg IV. Decreases nausea and straight forward choice to insert a permanent
vomiting. pacemaker. Early intervention are very
necessary for the recovery of the patients, also
Tab. Orcibest 10 mg contain orciprenaline as its the reducing the multiple genetrators and risk for
active medicine. it is useful in treating patients developing infection with the help of early
withbreathing difficulty due to the narrowing of intervention. Those are having a vascular
airway as asthma. also treat breathing difficulties. complication for that parmanat implantation is
remain a subject for the further investigation.
3.2.4 Proton pump inhibitors (PPIs)
She already diagnosis as a ischemic heart
Inj. pantoprazole 40 mg IV. Pantoprazole is more disease before one year and hypertension is the
effective than H2receptor blockers in reducing secondary diagnosis. A report of ECG,
gastric acid secretion. Echocardiography and Angiography showing the
complete heart block in third degree. The patient
3.2.5 Oxygen therapy going through placement of permanant
pacemaker after that patient not develop any
oxygen administration 4 liters/min through a complication and patient response is positive for
nasal catheter if needed. the treatment. The patient had further
investigations to find out the cause of complete
3.3 Nursing Management heart block.
First of all makes nursing assessment with the The patient reacted well to medication therapy,
help of observation to check the consciousness, but more approaches may be used in the future
Electical activity of heart by taking ECG, vital to help in further changes. healthy diet and
sign, electrolyte and body temperature. To make lifestyle modification help the patient to recover
the client lie comfortably in bed. After checking early and reduce further health problems.
vital signs ensure patient activity are normal.
o
elevate head end of the bed to 30 and railing 4.1 Prognosis
bed is provided and also monitor BP 6 hourly.
In elderly patients with symptomatic high-degree
atrioventricular (AV) block, permanent pacing
3.4 Nursing Diagnosis
can prevent repeated symptoms and decrease
mortality. Even so, long-term longevity has not
1. Acute pain related to decreased myocardial been clearly established with respect to similar
blood flow. control subjects [7].
Goal:- Reduce pain and make patient vitally
stable. Prognosis of patient it was good, patient give
Intervention: - Administer analgesic as per positive response to reatment and placing of
doctor order. permanent pacemaker and occurring any c
2. Ineffective breathing pattern related to omplication during treatment. Because of rapid
disease condition. recovery of patient doctor plan to discharge
Goal:- To improve the breathing pattern patient.
Intervention: Assess the respiratory function
and administer medication to maintain a 5. CONCLUSION
patent airway and to improve breathing
pattern. To give the prop up position. Hypertension and ischemic heart disease related
3. Impaired nutrition due to loss of appetite. the complete heart block is a common incident; It
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Dhobe et al.; JPRI, 33(46B): 546-550, 2021; Article no.JPRI.74283
is a major cause of mortality and morbidity in the prognosis of third-degree atrioventricular
elderly patient with complete heart block. She conduction block: the Reykjavik
fully depends on her family. So health talk taught study,” Journal of Internal Medicine.
them the importance of healty diet and life style 1999;246(1):81–86. View at: Publisher
modification at home after discharge and its Site | Google Scholar
usefulness in maintaining healthy life. 2. PREVALENCE of complete heart block -
Google Search [Internet]. [cited 2021 Feb
Being a health worker it’s an opportunity and 12].
responsibility to assist the patient and caregiver 3. Harris A, M. Davies, D. Redwood, A.
in the transition through acute hospitalization, Leatham, and H. Siddons, “Aetiology of
long –term care, procedure complication, chronic heart block. A clinico-pathological
rehabilitation, health education and family correlation in 65 cases,” British Heart
requires continuous nursing evaluation and Journal. 1969;31(2):206–218.View
intervention adaptation in response to evolving at: Publisher Site | Google Scholar
needs to maximise. 4. Yang YC, Pata RK, Aung TT. A Case of
Complete Heart Block With Diagnostic
CONSENT Challenge and Therapeutic Dilemma.
Journal of Investigative Medicine High
While preparing case report and for publication Impact Case Reports.
patient’s informed consent has been taken. 2018;6:2324709618788110.
5. Wang Q, Shang Y, Li S, Wu Y, Wang C,
ETHICAL APPROVAL Yan X. Complete heart block in systemic
sclerosis: A case report and
As per international standard or university literature review. Medicine. 2018;97(46):
standard written ethical approval has been e13226.
collected and preserved by the author(s). 6. Complete Heart Block Treatment [Internet].
ucsfhealth.org. [cited 2021 Feb 10].
COMPETING INTERESTS Available:https://www.ucsfhealth.org/Condi
Authors have declared that no competing tions/Complete Heart Block/Treatment
interests exist. 7. Shen W-K, Hammill SC, Hayes DL, Packer
DL, Bailey KR, Ballard DJ, et al. Long-term
REFERENCES survival after pacemaker implantation for
heart block in patients ≥65 years. The
1. Kojic EM, Hardarson T, Sigfusson N, American Journal of Cardiology. 1994;
Sigvaldason H. The prevalence and 74(6):560–4.
© 2021 Dhobe et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
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