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).

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