76 yo M PMHx DM, HTN, HLD, alcohol abuse w/ cc intermittent episodes of weakness and dizziness for the past 48 hrs.

Labs showed: Na 119, Mg 1.6, Cr 1.5. Severe hyponatremia, mild hypomagnesemia and mild AKI. Troponin was negative.

Atropine at the bedside and code cart outside of room, however patient required no intervention outside of electrolyte correction and was admitted to step down unit for severe hyponatremia and symptomatic bradycardia.

2nd Degree Heart Block, type I Mobitz, Wenckeback – secondary to profound electrolyte abnormality

• Typically a reversible condition that involves malfunctioning/conduction block at AV nodal cells
  • Mobitz II blocks involve His-Perkinjie system
• Common causes:
  • Drugs: BB, CCB, digoxin, amiodarone
  • Inferior MI
  • Myocarditis
  • Cardiac surgery
• Treatment:
  • Usually low risk to progress to third degree block
  • Patients typically respond to atropine
  • Permanent/emergent pacing is rarely required

Courtesy of Dr. Mike Murray

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