You are reviewing a 49 year old man who presented with chest pain and an unremarkable ECG. His observations remain within normal limits and your management plan was to repeat a troponin and ECG and discharge home with a stress test as follow up. His repeat ECG is below.
- Rate: Ventricular rate = 48 Atrial rate = 72
- Rhythm: Sinus rhythm with AV block
- Axis: Normal
- Morphology: Nil of note
- Intervals: PR QRS QTc all within normal limits in conducting beats
- Summary: Mobitz Type 2 with a 2:1 block. The narrow QRS indicates the failed conduction lies within the Bundle of His itself.
Other Details from history:
- Details re cause (history of Ischaemic chest pain, auto-Immune or Inflammatory of Infiltrative disease, drug history etc – see LITFL article linked below)
- Risk of progression to complete heart block
Further Reading – Textbook:
Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
Further Reading – Online: