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Old 08-16-2013
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EKG Question about Tx for Mobitz II

I frequently get this question wrong and the explanation in MTB is not comprehensive.

Someone please correct me if im wrong but heres what i know:
The diagnosis is usually straightforward and is based on characteristic EKG findings. Determining the site of the block is important to determine the correct management. A Mobitz I most likely has a block at the level of the AV node and best initial treatment is atropine for symptomatic patients. Asymptomatic patients just need to be observed.

The problem i have is with Mobitz II. This type of block is more commonly infranodal and atropine can make the block worse (see Medscape). So my questions are, when is:
1. transcutaneous pacemaker the correct answer?
2. transvenous pacemeaker the correct answer?

Please, no arrogant-ass "im right and you're wrong" answers. This is an open forum for people to discuss and learn. I'd appreciate a simple answer with an explanation and source.

Thanks.
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Old 08-17-2013
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ok the management for all the heart block is atropine first except Mobitz 2 and complete heart block. when you see a mobitz two, you reach for transcutaneous yourself and then get a consult for a transvenous. basically transvenous is harder to do than transcutaneous so you want to stabilize the pt asap. As far as complete heart block you will the do transcutaneous and then permanent pacemaker.
Hope it helps
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Old 08-17-2013
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Quote:
Originally Posted by Kais_MD View Post
ok the management for all the heart block is atropine first except Mobitz 2 and complete heart block. when you see a mobitz two, you reach for transcutaneous yourself and then get a consult for a transvenous. basically transvenous is harder to do than transcutaneous so you want to stabilize the pt asap. As far as complete heart block you will the do transcutaneous and then permanent pacemaker.
Hope it helps
Does that mean that transcutaneous pacing is always the best initial treatment regardless of whether the patient is stable or not?

Also, MTB step 3 says that atopine + pacemaker is the treatment for a 3rd degree block.
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Old 08-17-2013
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Quote:
Originally Posted by zeemd View Post
Does that mean that transcutaneous pacing is always the best initial treatment regardless of whether the patient is stable or not?

Also, MTB step 3 says that atopine + pacemaker is the treatment for a 3rd degree block.
well no your dangerous heartblock like mobitz 2 and 3rd degree wont be stable. you can try atropine for the other ones and observe. THere is no way you can treat 3rd degress with atropine because there is a block on AV node and nothing passes by. So what is atropine going to do. initial step is trancutanous pacing which is just a patch that you put on and then a transvenous. This patient will go on to get a permanent pacemaker. Also make sure to give midazolam before transcutaenous pacing since it can be uncomfortable shocking sensation for the patient.
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