Inferior MI, VEBs & Persistent Wenckebach

Report:

Sinus tachycardia 104/min

VEBs, frequent, multiform

Second degree AV block, Möbitz 1 (Wenckebach)

Late transition

Nonspecific intraventricular conduction delay (IVCD)

Acute inferior infarction

Anterolateral ST/T changes c/w MI/ischæmia

Comment:

The anterolateral ST/T changes are new and likely part of the inferior infarction; their location makes them unlikely to be reciprocal or to represent “independent” ischæmia. They are reported separately purely for descriptive purposes. The anteroseptal ST depression, however, is reciprocal and is not reported. In the presence of an obvious infarction it is best not to read too much into the ST/T changes elsewhere.

There are two consecutively conducted P waves, before 5th and 6th complexes, showing an increase in the PR interval, signifying Wenckebach conduction. There and elsewhere, full Wenckebach cycles take place, all terminated as expected by blocked P waves. What is not expected is that the frequent VEBs do not interfere with the sequences. This is most likely due to a two-level block61.

Yet another block is present here: the IVCD. Once upon a time it would have been called periinfarctional block. The term has no specificity and is best forgotten.

Her ECG three hours later is shown below (Fig 86a). A rhythm strip showing alternate-beat Wenckebach is shown in Fig 86b.