ECG showed third-degree heart block with mitral valve calcification. Please help.

Question

Hello doctor,

Three months back, an ECG detected a third-degree block with QT and QTc intervals out of the normal range. Rather than rush for a pacemaker, I turned to Ayurveda. A second ECG the next month found the block reduced to the second degree and the QT and QTc intervals normalized. But still, the pulse is low, and PR intervals are not being recorded. And an echo found that the posterior mitral annulus is calcified. All other cardiac valves are normal. LVEF is 65%.

Would the calcification of the posterior mitral annulus be the cause? The remedy in allopathy is the replacement of the mitral valve. Would there be a noninvasive approach?

Answer 1

Hello,

Welcome to icliniq.com.

I have gone through your query. Your ECGs (electrocardiography) suggest complete heart block and second-degree heart block, respectively (attachment removed to protect patient identity).

Echo information of mitral annular calcification is insufficient to comment on its management as there are no gradients mentioned in the echo report. So whether replacement of the mitral valve is required or not depends on whether the mitral valve calcification is severe enough to obstruct blood flow. In your case, I do not think so that you will require any valve replacement as of now. But better to get one proper echo done again with all blood flow gradients and all.

Secondly, very severe mitral valve calcification can at times lead to some AV (atrioventricular) blocks. But the most likely and common cause is degenerative changes in the conduction system due to age.

For the management of your heart blocks, I would like to know if you had any symptoms at the time when your ECG had shown complete heart block? Or any history of transient loss of consciousness or giddiness or fall anytime in recent times or before? So you have any other cardiac symptoms like breathlessness or chest pain? Have you done a 24-hour Holter monitoring recently?

Kindly get back with the above information to discuss the management strategy of your heart blocks. And also, send the most recent ECG if done.

Answer 2

Hello,

Welcome back to icliniq.com.

I have gone through your older Holter and present ECG (attachment removed to protect patient identity).

Previous Holter will not help us today in making any decisions. Either you should get it done again. But I do not think you require it as your current ECG and the one you have sent me in the previous query suggests that you have conduction system abnormality with an intermittent second degree and intermittent complete heart block. So, a permanent pacemaker is indicated and better if you get it done. It will pace or get used only if needed. Other times when you have your sinus rhythm, the pacemaker will act just as an observer and will not pace unnecessarily.

So I think you should think about it and get a permanent pacemaker implanted for your safety.