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Case studies on “Arrhythmias and Heart Block” provide detailed insights into the mechanisms, symptoms, diagnosis, and treatment of various arrhythmias and conduction disturbances within the heart. A 75-year-old man presented to the emergency department (ED) with the complaint of dizziness for the past week. He denied any chest pain, shortness of breath, tinnitus, hearing loss, or syncope.

Case Review

This case describes the importance of medication review in the elderly population. Elderly patients taking excessive atrioventricular (AV) node-blocking agents can have symptoms of dizziness and syncope with remarkable ECG changes. The temporal association of the medication dose increase and careful review of the medication list are key to diagnose the etiology of dizziness and AV block. β-Blockers (oral or topical) and calcium channel blockers can be offending agents for this presentation.

Progressive PR interval prolongation precedes a nonconducted P wave.

The first P wave after block conducts to the ventricle with a shorter PR interval compared with the last P wave before block.

High-grade AV block: Two or more consecutive P waves are nonconducted.

Role of the respiratory muscles, elasticity of lung tissue, and compliance of airways.

Mobitz type II second-degree AV block: Intermittently nonconducted P waves not preceded by PR prolongation and not followed by PR shortening.

Updates on clinical guidelines for both insomnia and sleep apnea management.

Case Discussion

Type II AV block is a disease of the conduction system in which conduction block occurs between the atria and ventricles, leading to 1 or more of the atrial impulses not conducting to the ventricles.