Wrong Footprints
Report:
Sinus rhythm
Non-conducted SVEBs
Trigeminy
Left bundle branch block
Comment:
Surprising number of staff reported these strips as Wenckebach (Möbitz 1) second degree AV block. The reason may be the memory of Marriott's injunction to "recognise Wenckebach by his footprints rather than his face"2. They would have done better to have heeded a more general maxim of Marriott's concerning the causes of pauses3!
At any rate, the non-conducted P' waves distorting the T wave before the (otherwise unexplained) pauses are easily seen to be premature in relation to the prevailing sinus rate. In both Möbitz 1 and Möbitz 2 AV block, the blocked P waves are on time or only slightly early due to the ventriculophasic effect or sinus arrhythmia.
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