Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of intermittent bradycardia and symptomatic episodes of lightheadedness/presyncope. ECG demonstrates a constant PR interval preceding dropped QRS complexes, consistent with Mobitz II second-degree AV block. Patient denies chest pain or dyspnea but reports episodes of fatigue and palpitations. No history of recent MI, cardiac surgery, or electrolyte disturbances.
Clinical Examination Findings
Cardiovascular exam reveals a regular rhythm with intermittent dropped beats, resulting in an irregular pulse. Heart sounds are S1 and S2 present, no murmurs, rubs, or gallops. Peripheral pulses are diminished during dropped beats. No signs of congestive heart failure (no JVD, no peripheral edema, lungs clear to auscultation). Neurological exam is non-focal.
Treatment Protocol
Immediate cardiology consultation for potential permanent pacemaker implantation. Discontinue any AV-nodal blocking agents (e.g., beta-blockers, non-dihydropyridine calcium channel blockers, digoxin). Continuous cardiac telemetry monitoring initiated. Prepare for transcutaneous pacing if patient becomes hemodynamically unstable.