Vagotonia: Advanced Second Degree AV Block

Report:

Sinus rhythm

Advanced second degree AV block[!xe "Second degree AV block" \t "See AV block, second degree"!]

Period of asystole

Ventriculophasic sinus arrhythmia

Comment:

Vagally-mediated bradyarrhythmias may, at times, be fatal. Vast majority are benign. This one resolved before any treatment could be given (always the patient’s best bet) and without any sequelæ.

Note the absence of any compensatory sinus tachycardia. This is characteristic of vagally mediated AV block.

The P waves “cling” to the remaining QRS complexes through ventriculophasic sinus arrhythmia. Why is another matter. Suffice it to say that several theories exist.

Fig 72. 77 year old woman with gross hypoxia and mixed acidosis. What is the nature of the early beats?

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