History of Present Illness:

A man in his mid 70’s is sent to the ED by his PCP for 1 week of exertional chest pain lasting minutes and an abnormal ECG with bradycardia.  He is asymptomatic at rest

Vital Signs & Physical Exam:

Vital signs are normal except for a HR in the low 40’s.   Physical exam is otherwise normal

An ECG is done

Computer Read:

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 THE EKG ANALYSIS & 1-MINUTE CONSULT

 

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ANSWERS:

  • 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 – BEST ANSWER –   2 to 1 AVB: If 2 P’s per QRS can be Mobitz I or II; I more likely but safer to assume II, esp if QRS wide
  • E) 3rd degree AV block 

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CASE CONCLUSION: Went to cath lab for urgent temporary pacemaker

CASE LESSONS:

2 to 1 AVB: If 2 P’s per QRS can be Mobitz I or II; I more likely but safer to assume II, esp if QRS wide