Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms suggestive of intermittent bradyarrhythmia, including episodes of dizziness, lightheadedness, or near-syncope. ECG demonstrates progressive PR interval prolongation followed by a non-conducted P wave (grouped beating), consistent with Mobitz I (Wenckebach) AV block. No history of syncope, chest pain, or dyspnea at rest.
Clinical Examination Findings
Cardiovascular exam reveals an irregular pulse rhythm corresponding to the dropped beats. Heart sounds are regular with no audible murmurs, rubs, or gallops. Peripheral perfusion is adequate; no signs of congestive heart failure or hemodynamic instability noted. Vital signs stable, though bradycardia may be present depending on the conduction ratio.
Treatment Protocol
Asymptomatic patients with Mobitz I AV block generally require observation and serial ECG monitoring. If symptomatic, evaluate for reversible causes including medication effects (beta-blockers, CCBs, digoxin) or electrolyte imbalances. Discontinue rate-limiting agents if clinically appropriate. If hemodynamic instability persists, consider atropine or temporary pacing. Long-term pacemaker implantation is rarely indicated unless high-grade block develops.