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    Congestive Heart Failure and Third-Degree Heart Block

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    You are a third-year medical student on the first day of your cardiology rotation. Obviously, you are nervous and want to impress the attending physician, Dr, Jackson, who has made it clear that he is a very important man who doesn't really have time to mess around with lowly medical students.

    "OK," he says, "let's see if you already know anything. Take a minute to look at Mrs. Svoboda's chart, she's a textbook case of what we see around here, and then let's talk about it."

    Mrs. Svoboda is an 81-year-old woman with congestive heart failure. She had smoked for 60 years, but was able to successfully quit when she received her diagnosis four years earlier. She was in the hospital because she had fainted at home. Her EKG pattern had revealed the presence of third-degree heart block and resulting bradycardia.
    Use the information from this sheet and any other reliable resources available to you to answer Dr. Jackson's following questions.

    1. What is congestive heart failure?
    2. What is third-degree heart block? What would the EKG tracing of someone with third-degree heart block look like?
    3. Why would third-degree heart block cause bradycardia?
    4. What treatment would you recommend for Mrs. Svoboda?

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    Solution Preview

    1. Congestive heart failure is another term for chronic heart failure. Basically. this is caused by the impaired function of the heart to properly pump out the blood to systemic circulation resulting in cardiac insufficiency. The term "congestion" means venous congestion. This occurs because the heart can't keep up with the amount of blood that is being filled into the heart from returning venous circulation. This results in symptoms such as pulmonary edema, swelling, dyspnea (difficulty in breathing, can't get enough air), orthopnea (can't sleep while lying down) and many more.

    2. Third ...

    Solution Summary

    We discuss a case of congestive heart failure with complete (third-degree) heart block. We discuss pathophysiology of disease, how to recognize the block from an EKG trace and treatments.