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
1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook
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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