how's it going guys P level question ECG Step One internal medicine Tock six-year-old woman asymptomatic ree G shown question wants to know uh what our diagnosis is and what the treatment is choices A and B first degree heart block wrong answer so if it's first deegree we're merely going to have a long PR interval greater than 200 milliseconds I don't really know to tell you okay so the P wve that occurs before the QRS you would just note that it looks extra long and the patient would be asymptomatic and you don't have to treat it okay so the problem can be at the AV node wrong answer Choice B moits one wrong answer so we talked about the secondary heart blocks moits one and two mobitz one AKA wanky back okay no idea why it has that name but mobit one is when you have a gradually prolonging PR interval followed by a dropped QRS okay so you'll just notice that let's say they give you uh six QRS complexes and they're just you can see one is clearly just not shown up and you can see prior to that dropped QRS the PR interval is gradually prolonging and then you have the dropped car S as I just said you don't need to treat it for us smla okay so type first scre heart block and mopit one no treatment for us smla wrong answer moits 2 wrong answer so mobitz 2 unlike mobitz one you're not going to have a gradually prolonging PR interval followed by the dropped QRS okay so you'll just have a random dropping of the QRS complex sometimes there can be a pattern to it can occur every two every three okay you can have a 2:1 3:1 type of pattern uh but on one of the newer nbmes for step two I've actually seen two to 3: one really relationships for Mo for this a moits one question the point is moits one gradually prolonging PR interval followed by the drop Qs moits 2 you do not have a gradually prolonging PR interval you just get a random dropping of the QRS it's dangerous okay there's a high probability of descend descending into third degree so they want pacemaker for us moits 2 wrong answer third degree correct answer okay so here on the ECG you see a super slow heart rate so the qrs's they are there's two things you're going to be looking for okay on the ECG number one super slow heart rate where seven eight boxes large boxes apart so you're going to be seeing the ventricular Escape Rhythm okay it's a heart rate of 30 to 40 so you'll get the ECG strip and you say I suck at ECGs but I just say hold on a second you see how the q's are super far apart okay that's the first thing you notice for third degree the second thing you're notice is that there's no relationship between between the p waves and the Qs complexes it's Qs on the left here doesn't look like the p wve is before it I mean you just don't see it there then the second one it's well before it the third one it's right before it so there's no relationship uh and this is because you have a complete Severance of electrical signal from the super ventricular domain down to the ventricular domain at the AV node okay so mobit too I mean you can have hisper Ki fiber malfunction we said first degree mobitz one is Av node mobitz 2 hisper kinji third degree can technically be AV node or hisper kinji you SM really doesn't give a okay I'm just elaborating for some of you who want some context so they want pacemaker for you SM you need to know that pacemaker is going to be for mobitz 2 and third degree fanii just threw in randomly to be a okay canide is a type 1 C sodium channel blocker that's first line Rhythm control for atrial fibrillation patients who have no structural or coronary artery disease so let's just hop to the final ones wolf Parkinson White wrong answer so procan can be a treatment for that wolf Parkinson White is just a re-entrant tachic cardia variant and you can get a Delta wave OMG okay it's a slur up stroke of the curs mostly garbage wrong answer you know the deal to make more content like my stuff Channel appreciate your time that's it