Case 5 Answer

Rate -about 40
Rhythm - second degree block type 2
Intervals - prolonged qrs in V2 consistent with right bundle branch block
Axis - left axis deviation from anterior fascicular block
Hypertrophy - none
Infarct - none
Clinical correlation - This older patient has a bifascicular block combined with a Mobitz II block and this setting often antedates complete heart block. Etiologies include conduction system disease, drug effects, and myocardial ischemia. In this case the patient was admitted to the hospital with his symptomatci high degree block. Cardiac enzymes were negative for myocardial infarct and a cardiac pacemaker was inserted with excellent results - etilolgy was conduction system disease (presumed Lev's or Lenegre's disease).

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