case_images: PMC9891312_01
case_images: Initial EKG that showed a sinus rhythm rate of 66, atrial premature complex, PR 142, QRSD 89, and QTc 393. EKG: Electrocardiogram
case_images: cureus-0015-00000033271-i01.jpg
case_images: PMC9891312_01_cureus-0015-00000033271-i01.jpg
case_images: FIG1
case_images: Upon arriving at the ED, she was asymptomatic, and her electrocardiogram (EKG) showed sinus rhythm (Figure 1).
case_images: Telemetry strip from a home heart monitor. In rhythm strip A, if you look at the red double-sided arrow you can see the prolonged sinus pauses that were recorded. In rhythm strip B, if you look at the orange single-sided orange arrow, you can appreciate the prolonging P-R interval followed by dropped beats consistent with second-degree AV block Mobitz type 1. In rhythm strip C with the green arrows, you can see consecutive P waves that do not conduct which is suggestive of a high-grade AV block. . AV: Atrioventricular
case_images: cureus-0015-00000033271-i02.jpg
case_images: PMC9891312_01_cureus-0015-00000033271-i02.jpg
case_images: FIG2
case_images: The available tracings from these events reveal complete heart block with a feature of first-degree AV block and second-degree AV block Mobitz type 1 (Figures 2, 3).
case_images: Home heart monitor strips. In the bottom strip you can notice initially that the P waves have no associated QRS. P wave with a QRS is shown by a thick black arrow. The next beat was a P wave with a dropped QRS followed by P waves with associated QRS. You can notice that the pink arrow has a P to R interval shorter than the following P-R intervals. The blue arrows have P-R intervals of the same interval that is longer than the preceding pink arrow consistent with a first-degree AV block.. AV: Atrioventricular
case_images: cureus-0015-00000033271-i03.jpg
case_images: PMC9891312_01_cureus-0015-00000033271-i03.jpg
case_images: FIG3
case_images: The available tracings from these events reveal complete heart block with a feature of first-degree AV block and second-degree AV block Mobitz type 1 (Figures 2, 3).