The ECG shows Mobitz type I (Wenckebach) second degree AV block with variable conduction. You can see both 2:1 and 4:3 conduction patterns. Look closely for the classic progressive PR lengthening before a dropped beat.
I've marked the P waves on the ECG to help you track the rhythm more easily.
Clinical clue: In an older patient without prior medical history, this is most likely due to age-related degeneration of the AV node. But remember, whenever you see a second-degree AV block, it's important to also rule out other causes like ischemia, electrolyte disturbances, medications, or increased vagal tone.
ECG.CASESA 78-year-old woman shows up with fatigue and a bit of lightheadedness over the past few days. No chest pain, no fainting. Vitals are stable. But her ECG tells a different story.
A 78-year-old woman shows up with fatigue and a bit of lightheadedness over the past few days. No chest pain, no fainting. Vitals are stable. But her ECG tells a different story.
The ECG shows atrial flutter with 2:1 AV conduction. Flutter (F) waves are clearly visible and have been marked with red arrows, most prominent in inferior leads.
Atrial flutter often presents with a regular tachycardia around 150 bpm. In patients over 60 with new-onset palpitations and a regular rhythm, always keep flutter in mind. Recognizing the pattern early can prevent misdiagnosis and lead to more effective management.
Did you spot the flutter waves? Let’s hear your thoughts below.
A 65-year-old female presents with palpitations that started a few hours ago. She feels slightly lightheaded but denies chest pain or shortness of breath. Blood pressure is stable.