Cardiology Report PEARLS 10/27: Heart Block and Cardiomyopathy

Take-home pearl: if you see a patient with 2:1 AV block, you can get them to exercise to increase chronotropy and see what happens to the heart rate. If it’s Wenckebach, the HR will tend to increased normally. If it’s Mobitz Type II (i.e. infranodal disease in the His-Purkinje system), exercise can actually worse the AV block.

Additional learning

  • Check out this previous blog post for the ddx of complete heart block
  • Cardiomyopathy: the patient we discussed today has a cardiomyopathy by imaging, but the etiology is unclear. The terminology used around cardiomyopathy can be confusing. There are different classification schemes for cardiomyopathy (WHO vs AHA vs ESC). In general, you can break it down into the following framework:
    • Familial vs Non-familial
    • Anatomic and physiologic phenotype
      • Hypertrophic (can include amyloid, athleticism, in addition to the genetic association we often think about)
      • Dilated (myocarditis, drugs, alcohol, sarcoid etc.)
      • Restrictive (amyloid, scleroderma, radiation, drugs)
      • ARVC
      • Unclassified (e.g. takotsubo)

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