Wenckebach AV Block in Marked Sinus Tachycardia
Report:
Sinus tachycardia 138/min
Second degree AV block, Möbitz 1
Probable acute inferior infarction
Comment:
It is unwise, generally, to diagnose infarction from rhythm strips, but this one has all three indicative changes of acute infarction: Q wave, ST segment elevation and T wave inversion.
The strip is remarkable for large P waves disappearing into the descending limb of T waves. The pauses starting with blocked P waves appear empty, although the buried P waves can be discerned at the expected distance from their neighbours.
Bigeminy due to 3:2 conduction is shown below (Fig 119a).
Fig 119a.
Fig 120. 75 year old hypertensive woman recovering from a CVA, on digoxin and enalapril for left ventricular failure. Her sinus rhythm has few opportunities in this trace; when it gets them, it hurries to be conducted to the extent that it becomes faster than itself!
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