An 83-year-old female with recent colectomy for mesenteric ischemia was seen at a local hospital because of recent syncopal episodes. She has type 2 diabetes mellitus. She was transferred because of ECG findings post-colectomy. An ECG performed in the emergency department (Figure 1) is similar to that performed at the local hospital.
Figure 1
Figure 1
The ECG shows which of the following:
Show Answer
The correct answer is: A. Second degree atrioventricular (AV) block – Mobitz I.
The ECG shows sinus rhythm with evidence of 2:1 block with narrow QRS which is most likely due to second degree AV block – Mobitz type I. Inferior injury is present as well as posterolateral injury (ST depression in lead V2) rather than anterior sub-endocardial ischemia (red arrows), The P-P interval is constant due to 2:1 AV block (blue arrows); therefore, blocked PAC is not correct. The patient went to the catheterization lab with the finding of 99% diffuse right coronary obstruction. The combination of right coronary disease and AV block has been reported.1
Figure 2
References
Wei S, Zhong L, Chen S, Li X. The status of coronary artery lesions in patients with conduction disturbance. J Cardiovasc Med 2011;12:709-13.
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