Q. My friend has a second-degree heart block and low blood pressure. How to get it treated?

Answered by
Dr. Ilir Sharka
and medically reviewed by Dr. Nithila A

Hello doctor,

My boyfriend is 24 years old. Being a fitness trainer, he does not take any drugs. He has been getting chest pain for the past four months and sometimes lightheadedness. He went to the doctor and had done a blood test which came back normal. His blood pressure is low, and he had a 24-hour Holter monitoring and ECG. The results came back as second-degree heart block four times in 24 hours. Our appointment with cardiologist is after a month. I am worried because he feels weaker when he exercises and the pains are more frequent. Not sure what we can do in the meantime or what is causing it.

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Dr. Ilir Sharka

FACULTY OF MEDICINE, UNIVERSITY OF TIRANA., POST-GRADUATION RESIDENCY CARDIOLOGY, DEPARTMENT OF CARDIOLOGY,
Cardiology

Hello,

Welcome to icliniq.com.

I understand your concern. I want to explain that when we are in front of a cardiac conductance abnormality in an young adult first, it is necessary to exclude an infectious and inflammatory disease, like Lyme disease, sarcoidosis, and other cardiac issues, like myocarditis, and anomalous coronary artery, etc.

It is necessary to undergo a full blood test panel and a cardiac ultrasound test. For a more detailed cardiac tissue characterization, it is necessary to undergo a cardiac magnetic resonance imaging test (CMR). Meanwhile, I recommend that your friend refrains from competitive sports and any excessive physical exertion. I hope it is helpful for you.

Thank you doctor,

His job is in sports so he cannot refrain from that. Are there any blood tests we can do in the meantime with our general physician. And is heart block very dangerous? How are myocarditis and Lyme disease detected, either through blood test results or scan?

Also, should we try to get these tests done privately or do you think waiting one month would not be too long for these symptoms? Does the blood tests we had done at the initial time have shown up Lyme or myocarditis? He had done a blood test before a month. Also, the ECG showed his heart was otherwise performing at the optimum level.

Dr. Ilir Sharka

FACULTY OF MEDICINE, UNIVERSITY OF TIRANA., POST-GRADUATION RESIDENCY CARDIOLOGY, DEPARTMENT OF CARDIOLOGY,
Cardiology

Hello,

Welcome back to icliniq.com.

First, I would explain that it is not necessary to avoid his job. To be careful and not participate in strenuous physical activities until the real cause of his heart block is clarified. In an aged individual, a heart block raises suspicions about degenerative fibrotic lesions of the cardiac conductance system. But, when in front of a young adult an inflammation or infection issues should be first suspected.

Meanwhile, you are waiting for the doctor appointment, you may check cardiac enzymes CK-MB (creatine kinase-muscle/brain), and troponin, if elevated would indicate a cardiac muscle injury. You may also check inflammatory markers like PCR (polymerase chain reaction), and ESR (erythrocyte sedimentation rate), etc.

For Lyme disease, it is necessary to perform a serologic test for borreliosis (but should be guided by his doctor). Regarding myocarditis, the discussion is a little difficult, because several specific tests need to be performed like cardiac ultrasound, cardiac MRI and sometimes even cardiac biopsy. If your boyfriend has experienced recently any episode of fever, or signs of acute infection (respiratory, etc.) the suspicion about a myocardial inflammation is high.

Now returning to the safety issue, I would recommend performing the cardiac enzymes. If the chest pain persists and if the result are elevated have medical assistance as soon as possible and not to wait a month for doctor appointment. This is my opinion.

Thank you doctor,

Please could you tell me what are cardiac enzymes?

Dr. Ilir Sharka

FACULTY OF MEDICINE, UNIVERSITY OF TIRANA., POST-GRADUATION RESIDENCY CARDIOLOGY, DEPARTMENT OF CARDIOLOGY,
Cardiology

Hello,

Welcome back to icliniq.com.

Cardiac enzymes are components of cardiac cells. When myocardial cells are damaged the enzymes get out and show an increased percentage in the circulating blood. The doctor may check CK-MB and troponin. I hope you have information now to understand the importance of this clinical condition.

Thank you doctor,

He has low blood pressure, is that symptomatic of the infections? Also is there any good supplements he can take in the meantime? Also the chest pain he gets is not in the centre of his chest but rather in the left side. He actually has a cold at the moment and his symptoms have worsened but he got these pains before four months around the same time I contacted pneumonia.

Dr. Ilir Sharka

FACULTY OF MEDICINE, UNIVERSITY OF TIRANA., POST-GRADUATION RESIDENCY CARDIOLOGY, DEPARTMENT OF CARDIOLOGY,
Cardiology

Hello,

Welcome back to icliniq.com.

He may use CoQ10 (Coenzyme Q10) supplement which is an active substance. As a history of recent respiratory infection is present, I recommend him to proceed with the above-mentioned lab tests. In addition, pain relief medication like Ibuprofen or Naproxen may be used.

Thank you doctor,

What is the low blood pressure meaning? Also what is the difference between Lyme disease and myocarditis in heart symptoms. Is he at risk of a heart attack in this time before appointment?

Dr. Ilir Sharka

FACULTY OF MEDICINE, UNIVERSITY OF TIRANA., POST-GRADUATION RESIDENCY CARDIOLOGY, DEPARTMENT OF CARDIOLOGY,
Cardiology

Hello,

Welcome back to icliniq.com.

First, before concluding on low blood pressure values, it is necessary to closely monitor BP values for a couple of days up to a week. Also, it is important to avoid dehydration by taking plenty of fluids. An overall cardiac function should be reviewed. A cardiac ultrasound would help in this regard.

It is difficult clinically to differentiate different causes of inflammatory heart disease. The blood test mentioned earlier would help. It does not seem to be ischemic heart disease. Nevertheless, if the symptoms give him important limitations during his daily activity, it is necessary to ask medical assistance before an appointment.

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