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To solve this case, we need to be suspicious as to why the patient has bradycardia, when they are not on a beta blocker.
The money is in the ECG. This is a MOBITZ II with a 2:1 Block
The problem with Mobitz II blocks like this is that they can deteriorate into a complete heart block.
​The patient had a pacemaker inserted.

In last week’s EMQA we spoke about a 2:1 block where the p waves were hidden in the T waves. These are not hidden.

  • AMI
  • Hyperkalaemia
  • His-Purkinge System Failure below AVN
  • Conduction System Fubrosis
  • Drug related: Amiodarone, Beta blockers, Calcium Channel Blockers, Digoxin
  • Inflammatory/Autoimmune: Myocarditis, Rheumatic Fever, SLE

If you are a member of the Cardiac Bootcamp Self Study Course, go to the section on Mobitz Blocks and review.

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