Let the Sleeping Dog Lie?

Report:

Sinus arrhythmia 45 - 68/min

Second degree AV block

Two blocked P waves

Comment:

It is disconcerting to see a spontaneous 3.7" pause, but (i) the patient had a recent inferior MI and (ii) remained asymptomatic during similar episodes while awake. Further, the whole episode looks “vagal”, with concomitant slow phase of marked sinus arrhythmia.

Sustained second degree AV block in the setting of inferior MI may be a sign of (non-infarct-related) LAD disease5.

The few blocked P waves are best left alone.

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