Name that rhythm...

wanderlustRN24 · May 28, 2012

Sinus brady with 1st degree AV block, maybe? Not a rhythm queen, but that's what I see at first glance!

SummitRN, BSN, RN · May 28, 2012

I was thinking a 2:1 AV Block, Mobitz II

Indeed. Bradycardic mobitz type II with 2:1 conduction...

I'd want to see a 12 lead stat as that looks like ST depression and long QT, but it is hard to tell from a telemetry print.

Sinus brady with 1st degree AV block, maybe? Not a rhythm queen, but that's what I see at first glance!

Yes on the brady. No on the 1st degree block; that would simply mean the PRI is pretty regular and longer 0.2sec. You can readily see every other p-wave is nonconducting.

morte, LPN, LVN · May 28, 2012

Electrocardiogram of patient with Mobitz II second-degree atrioventricular block. Mobitz II atrioventricular (AV) block with intermittent periods of 2:1 AV block. If only 2:1 block was seen in beginning of strip, site of block could not be localized with certainty; however, single dropped QRS complex at end of strip with constant PR interval indicates that this block is localized in one of the bundle branches. Evaluating for stability of the sinus rate is important because conditions associated with increases in vagal tone may cause simultaneous sinus slowing and AV block and therefore, mimic a Mobitz II block.

In addition, diagnosing Mobitz II block in the presence of a shortened postblock PR interval is impossible. This sequence can be secondary to enhanced conduction or a nonconducted P wave occurring with a junctional escape beat. Prolonged ECG recordings or intracardiac recordings may be needed to establish the correct site of block (ie, AV nodal or infranodal).

Mobitz II block is typically associated with significant underlying conduction system disease. Therefore, the QRS complex is usually wide, and the PR interval is usually normal. However, a long PR interval and a narrow QRS complex do not exclude Mobitz II block, because AV nodal conduction disease may coexist with an infranodal lesion. Another consideration in a Mobitz II block with narrow QRS is atypical Mobitz I block.

A Mobitz I block with a narrow QRS complex is almost always located in the atrioventricular node

OnlybyHisgraceRN, ASN, RN · May 28, 2012

Mobitz II!!!!

Esme12, ASN, BSN, RN · May 28, 2012

Mobitz II.....2:1 heart block.The PR interval is consistent and there are 2 "P" waves for every QRS.

GitanoRN, BSN, MSN, RN · May 28, 2012

hmmm lovely....mobitz type ii av block, in which the pr interval remains unchanged prior to a p wave that suddenly fails to conduct to the ventricles...on the same level one could say, advanced second degree av block, in which two or more consecutive p waves are nonconducted. although in contrast to third degree or complete heart block, however, some p waves continue to be conducted to the ventricle.... let's see what other opinions might say after mine.....aloha~ :redbeathe

*LadyNurse* · May 28, 2012

Just a little Hx:

This rhythm belongs to a 44 y/o female admitted with ARF secondary to a vanco trough of 44! She has a history of recent endocarditis (hence the home vanco) and a mitral valve replacement. She also had breast CA with bilateral mastectomy and nonhodgkins lymphoma.

Thanks for your imput guys, much appreciated!

GitanoRN, BSN, MSN, RN · May 28, 2012

is this school related?....my apologies don't mean to offend if you're an rn already.... hugs :hug: & aloha~

loveu123 · May 29, 2012

2nd degree AV block, type 2.

*LadyNurse* · May 29, 2012

No, I'm not a student. LOL.

I'm just not a Rhythm Queen, either. I'm that nurse that will need her calipers and a quick reference guide.

No offense taken.

brillohead, ADN, RN · May 29, 2012

From a student's perspective, does anyone have any favorite websites or books for learning to read strips?

I have Med-Surg III in the fall, and my instructor is known as the Cardio-Queen... I'm going to need all the help I can get!