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Test yourself with this week’s ECG case. Then scroll down for a structured step-by-step interpretation and clinical pearl.
A healthy 20 year old presented with post-viral palpitations
The final ECG interpretation was labeled as Mobitz 2 – do you agree?
There’s a regularly irregular rhythm from dropped beats. There’s a normal P-P interval before the drop (ie not a blocked PAC), but the PR interval increases before the drop (with the longest interval before the drop and shortest after the drop)
Mobitz 1 (Wenckeback), not Mobitz 2.
Troponin was mildly elevated and the patient was diagnosed with viral myocarditis. ECG the next day had resolution of Mobitz 1, and lyme serology was negative.
Mobitz 1 can be identified by normal P-P (not blocked PAC), and PR prolongation (not Mobitz 2) – with the longest PR before the drop and shortest after
