Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with intermittent episodes of lightheadedness, presyncope, and fatigue. ECG demonstrates a stable PR interval followed by an unexpected non-conducted P wave, consistent with Mobitz II second-degree AV block. No history of recent myocardial infarction or electrolyte disturbance. Symptoms are exertional in nature.
Clinical Examination Findings
Cardiovascular exam reveals an irregular pulse with dropped beats. Heart sounds are S1 and S2 with no murmurs, rubs, or gallops. Peripheral pulses are diminished in intensity during dropped beats. Patient is hemodynamically stable at rest, but exhibits bradycardia. No signs of overt congestive heart failure or peripheral edema.
Treatment Protocol
Immediate cardiology consultation for potential permanent pacemaker implantation. Discontinuation of AV nodal blocking agents (beta-blockers, calcium channel blockers, digoxin). Continuous cardiac telemetry monitoring. Prepare for transcutaneous pacing if patient becomes hemodynamically unstable.