History of Present Illness:
An elderly male with a history of bradycardia and HTN only on HCTZ presents for generalized weakness and a fall. He was on his bedroom floor all night. He denies pain in the chest or other complaints.
Vital Signs & Physical Exam:
Vital signs are normal except for a pulse of 40 . Physical exam is otherwise normal but she is in the hallway.
An ECG is done
Computer Read: SB at 40 with first degree AVB, LAFB and moderate TWA
What is the most likely rhythm in this patient?
- A) Sinus bradycardia with PAC’s
- B) 1st degree AV block
- C) 2nd degree AV block, type 1
- D) 2nd degree AV block, type 2
- E) 3rd degree AV block
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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ECG interpretation: The ECG shows 2 P waves for every QRS so there is 2 to 1 heart block (n many of the leads every other P wave is partially hidden at the end of the T wave). There are also inverted and/or biphasic T waves in the lateral and precordial leads that could be from ischemic reperfusion (Wellens waves)
ANSWER: What is the most likely rhythm in this patient?
- A) Sinus bradycardia with PAC’s
- B) 1st degree AV block
- C) 2nd degree AV block, type 1 – CORRECT – This is most likely than type 2. However, since block is 2:1 safer to assume it is or could be type 2
- D) 2nd degree AV block, type 2
- E) 3rd degree AV block
1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook