Advanced Second Degree AV Block

Report:

Sinus tachycardia 100/min

Second degree AV block, advanced

ST/T changes consistent with MI/ischæmia

Comment:

The conducted P waves are all associated with slightly variable first degree block and the QRS complex is narrow: the site of the block is the AV node. Less than half are conducted. The block is therefore advanced (high-grade) one. It was still present the following day (Fig 84a).

There are abnormal Q waves in 3 and aVF, with small but significant Q in lead 2; lead 3 shows ST elevation and T inversion consistent with infarction. Further, there is precordial “plane” ST segment depression with sharp ST/T angle; some reciprocal, some perhaps reflecting remote ischæmia.

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