BAcquired nonsurgical heart block

Idiopathic.

Associated with congenital heart defects. Infectious diseases: myocarditis (viral or Lyme) or endocarditis.

iv. Connective tissue diseases: lupus, rheumatic fever.

v. Kawasaki disease.

vi. Muscle disease.

vii. Cardiac tumor.

viii. Cardiac sclerosis.

c. Postsurgical. Incidence < 1% because of improved operative technique.

i. Transient. Resolves within 8 days.

ii. Permanent. Usually develops immediately after surgery but may occur many years later.

2. Sick sinus syndrome. Depressed sinus node function.

a. Presentation. Sinus bradycardia or slow junctional rhythm alternating with episodes of tachycardia. May present with syncope.

b. Causes. Surgery to correct atrial septal defect, Mustard procedure for d-transposition of the great vessels, Fontan repair for single ventricle complexes, viral myocarditis, idio-pathic.

G. Toxins. Common drugs and toxins that can cause bradycardia include:

1. Antidysrhythmics.

2. a-Adrenergic agonists.

3. ^-Adrenergic agonists.

4. Calcium channel blockers.

5. Ciguatera.

6. Clonidine.

7. Digitalis glycosides.

8. Opioids.

9. Organophosphates and carbamates.

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