79 year old male with fatigue.
Question 1: What are possible causes of the patient's fatigue?
Question 2: What is the location of block for the "dropped" P waves in this patient?
-2nd degree AV block type I (Mobitz I)
-Av block, second degree-Mobitz type II (Wenckebach)
-Low voltage, limb leads
Question 1: Conduction System Disease, Excessive doses of AV nodal blocking agents, and Hypothyroidism.
Question 2: Usually P waves fail to conduct in the AV node during periods of Wenckebach. This is probably true for this patient. However, the last non-donducted P wave falls before the T wave and could have potentially blocked in the ventricular myocardium (ventricular refractory period).