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Case Report On : Complete Heart Block

When the electrical signal normally does not travel from the atria, the upper chambers of the heart, to the ventricles, or lower chambers, full heart block occurs. During surgery, the atrio ventricular (AV) node is weakened and complete heart block can result. Often, complete heart block occurs naturally without surgery [1]. Patient History: Heart block is an irregular heart rhythm where the heart (bradycardia) beats too slowly. In this condition, between the upper chamber (atria) and the lower chamber (ventricles), the electrical signals that tell the heart to contract are partially or completely blocked. Present historyThe patient 71-year old male who was admitted to hospital on date 25/11/2019 with the chief complaint was severe chest pain, breathlessness, excessive palpitation, vertigo, and sweating since in 4 months. Conclusion: The patient was admitted in the hospital with the chief complaint of severe chest pain, breathlessness, excessive palpitation, vertigo and sweating since 4 months and his condition was very critical and the patient was admitted in AVBR Hospital and immediate treatment was started. Case Study Dhengare et al.; JPRI, 33(59A): 82-87, 2021; Article no.JPRI.77512 83


INTRODUCTION
Third-grade block heart is generally referred as whole block of heart (CHB). The tests for diagnosis incorporate the presence of a total dissociation of the atrioventricular (AV) in the a greater atrial rate than the ventricular. Most patients with CHB have strong bradycardia symptoms. Class I sign for all CHB symptom clients, whether congenital or obtain, involves implanting a permanent pacemaker (PM). Some portions of congenital complete heart block patients are the nonetheless asymptotic. A healing dilemma make an appearance in the absence of criteria for obtaining the maximum benefits from the therapy with preventive. We have a case of asymptotic congenital CHB with an get away rhythm that raises heart rates with physical activity and leads to a diagnostic challenge and a therapeutic approach [1].
More than 80% of these patients live in developed countries and there is no care for most of them. Complete Heart Block (CHB) is a cardiac disease associated with extremely low heart rates and if untreated, results in average longevity of only 2.5 years. Extrapolating the demographics of CHB in the United States to the global population, we estimated the global annual incidence of the disease in 2005 to be 430,000. European baseline data resulted in similar estimates. More than 80% of these patients live in developing countries and most do not receive treatment. In India and China alone, there were 140,000 new cases (50,000 in India) and less than 20% in each country received treatment [2].

Patient History
The male patient 71-year old who was admitted to AVBRH on date 25/11/2019 with the chief complaint of severe chest pain, breathlessness, excessive palpitation, vertigo, and sweating since in 4 months. After admitted in the cardiac ward. all investigations done like X-ray, ECG, 2 Day echo, CBC, Lipid profile, coronary angiography, PT or PT-INR Test, and permanent pacemaker done then implantation procedure was done on 27/11/2019.

Past History
The patient was having a history of hypertension for 3 years. He is a known case of hypertension so, patient take Tablet-Amlodipine He came with a complaint of chest pain in the hospital in 2009, so that time his EGC was normal.

Causes
Primary risk factors includes-hypertension, diabetes, cigarette smoking, obesity, and high serum cholesterol. Secondary risk factors includes -ordinary cardiac production (CO) control mechanisms, co depend on preload, after load, mycocardial contractility, heart rate and metabolic state of the individual. Major cause are coronary artery, hypertension, rheumatic heart disease, congenital heart disease, cardiomyopathy, anaemia, bacterial endocarditis, valvular disorders, acute myocardial infarction, dysrhythmias, pulmonary embolic, thyrotoxicosis, hypertension crisis, ventricular septal defect and myocarditis [3].

Classification of Heart Block
First degree heart block ( first degree AV block) • Second degree heart block (second degree AV block) • Third degree heart block is otherwise called as complete heart block.

5.
Echo cardiogram-Abnormal EF% 6. Chest X-ray-The presence of a permanentpacemaker in the right intra clavicular region. 7. Coronary angiography-This is a kind of xray that reveals coronary arteries using a dye. It will indicate whether the heart is narrowed or blocked . 8. Tilt table test-Involves the patient lying on a table that is then tilled with the patient's heart rate rhythm and at various points blood pressure is taken. 9. Cardiac stress test-This is when the patient has an ECG while the patient is working under pressure to show that the heart is working. 10. PT or PT-INR-Done (2.0 to 3.0) 11. Holter and Event Monitors-Abnormal heart rhythm.

TREATMENT


Nutritional Therapy
It is usually recommended that you eat low sodium (2-3 g / day) and avoid exaggerated amounts of liquid. This suggestion decreases fluid reservation and the symptom of peripheral and pulmonary swelling, though it has not shown to affect mortality rates.
The aim of sodium limitation is to reduce the volume that circulates, which decreases the heart's pumping capacity for this amount. The patient's ability to change his diet and the number of medications prescribed must be balanced. Any changes in diet must be made with regard to good nutrition and liking, dislikes and cultural patterns of the patient [5].

Surgical Management
 Permanent pace maker  Implantable cardiac defibrillators then, resynchronization therapy  Revascularization  Heart transplantation  Ventricular assist devices [4].

Nursing Management
The nurse will administer the medicine and evaluate the beneficial and harmful effects of the medicine on the patient. The type and dose of pharmacological therapy are determined by the balance of these effects. The following include care measures for the evaluation of therapeutic efficacy:  Maintain a negative balance intake and output record.  Weigh the patient regularly simultaneously and same weight, usually the morning after urination; track a 2-to 3-lb rise regularly, or 5-lb increments weekly;  Able to detect a rise or a decrease in pulmonary crackles at least regularly.  JVD degree determination.  Determination and assessment of dependent edema severity.  Pulse and blood pressure monitoring, and postural hypotension monitoring to ensure the patient is not completely dehydrated.  Symptoms of dehydration are tested for skin turgor and mucous membranes.

Nursing Diagnosis
The key diagnosis for HF patients may include the following on the basis of the assessment data: 1. Impaired cardiac tissue perfusion related to heart failure. 2. Intolerance (or risk to intolerance of activity) of activity related to decrease in CO between the supply of oxygen and demand. 3. Anxiety related to dyspnoea, breathlessness. 4. Impotence related to incapacity for chronic illness and hospitalization to play roles 5. Lack of knowledge related to daises process [5].

Collaborative Problems/ Potential Complications
On the basis of the evaluation results, the following may be possible complications: • Cardiogenic shock • Dysrhythmias • Thromboembolism • Pericardial effusion and cardiac tamponade

Continuing Care
For a patient who is hospitalised according to the physical condition of the patient and the availability of family support, a home referral might be suggested. Patients with older adults and people with long-standing cardiovascular diseases with impaired physics often need help during an acute episode of HF after hospitalization. Suggestions are necessary to adapt the home environment to the behaviour limitations of the patient. If the steps are the problem, the patient may plan the day to minimize escalation. The caregiver works with the patient and family to optimize their benefits.
The health care professional also reinforces and clarifies information on changes in the diet and fluids, symptoms and everyday body weights, and how important it is to obtain healthcare follow-up. Assistance can also be given in the preparation and management of appointments. The patient is advised to step up self-care and the duty to execute the therapy [5].

DISCUSSION
CHB occurs when atrial and ventral contractions are not coordinated at their own rate with each other to have a detrimental effect on the function of the heart. In AV node, for formatter sites, CHB may occur. Almost always, intranodal or Hisian blocks are marked by getaway rhythms with small QRS complexes, while infra-Hisian blocks often have broad QRS complex leaks. A number of articles related to cardiovascular health and risk factors are available [8][9][10]. Effect of Alirocumab was studied and reviewed by Bittner et al [11] on lipoprotein(a) and cardiovascular risk after acute coronary syndrome; by Goodman et al [12] on cardiovascular events after coronary bypass surgery and by Jukema et al [13] on recent acute coronary syndrome. Ray et al studied the Impact of alirocumab on cardiovascular and metabolic outcomes of acute coronary syndrome in patients with or without diabetes [14]. Similar studies were reported by Steg et al [15] and White et al [16].

STRENGTH
Patient was 71 year male patient tolerate all the medication and well response within seven days to the therapeutic treatment of the hospital which was given as a treatment.

CONCLUSION
The patient was admitted to hospital with the chief complaint was severe chest pain, breathlessness, excessive palpitation, vertigo and perfused sweating since in 4 months and his condition was very critical and the patient was admitted in AVBR Hospital, immediate treatment was started by health team member and all possible treatment were given and now the patient condition is satisfactory.

CONSENT
Before taking this case, information was given to the patients and their relatives and Informed consent was obtained from patient as well as relatives.

ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s).