new here... Mobitz II question

it's ok

by Tracey_E - 2022-02-27 08:54:50

Your doctor needs to follow up with you, but asymptomatic mobitz 2 is generally watched, not treated. If they were worried, you would have had a call by now.

Bradycardia is just a heart rate under 60. It's more of a symptom than a diagnosis. Many things can cause bradycardia.  Your rate is low enough to be labeled bradycardia, but it goes up on exertion and you are not symptomatic, so it's unlikely they'd do more than just keep an eye on it. 

PAC and PVC are generally considered benign. They are just extra little half beats between the full beats. A pacer would have no impact on these, it's a gas pedal not a brake. It would only make the heart beat faster. 

I would suggest getting a cardiologist to evaluate, not work through your primary on this. Odds are you are just fine and no action is needed, but it's good to get a specialist's opinion and continued follow up. 

Mobitz II

by AgentX86 - 2022-02-27 11:47:49

I disgree.  Mobitz II is the more dangerous second degree block and can easily (will) progress to a 3rd degree block.  It is a failure of the electrical system between the atria and ventricles and the failure will not resolve itself. The two-second pause is one skipped beat at 60bpm.  Mobitz II can be random, 2:1 then 3:1 (three second pause), or four, or....

Mobitz I has a P-wave -Pwave time that gets progressively longer until a QRS is missed (missed beat) then it resets and it all starts over.  Mobitz-II is a constant rate P-wave but some of the QRS complexes are dropped.  Effectively, the A/V node fails and the beat is dropped.

Mobitz-I is often caused by drugs (legal or otherwise) or the result of some disease and is usually temporary. When the underlying cause clears up, the heart goes back to normal.

Mobitz-II is permanent damage to the heart, somewhere between the A/V node and the LBB/RBB.

I don't mean to alarm you but this is a real concern. Fire your doctors, at once, and find a good cardiologist.  If you can, go directly to an electrophysiologist. If you have a (near) syncope event, go directly to the ER.

<https://litfl.com/av-block-2nd-degree-mobitz-ii-hay-block/>

Mobitz 2

by TAC - 2022-02-27 13:05:26

Mobitz 2 is a conduction defect that occurs below the A/V node. The P wave that initiates the heartbeat, is not being followed by the QRS complex or ventricular contraction. The conduction defect could be caused by a damage in the conduction fibers (fibrosis, scar tissue or isquemia). The symptoms can occur during exercise or at rest. The point is that the electric signals that begin in the atria to produce a ventricular contraction are being interrupted along the way. This conduction defect is structural and it won't go away. On the contrary, it will get worse. I concur with AgenX86 in advising you to see a heart doctor as soon as possible. I don't see why you should worry about developing atrial fib or any other arrhythmia, other than bradycardia. However, a complete A/V block is likely to occur at anytime. A pacemaker could be life-saving.

hi all

by zanyn7507 - 2022-02-27 13:57:24

so the report was just dropped by the cardiologist, no follow up and as I aaid only advice is don't take av nodal blockers. ( maybe they are waiting until my echocardiogram in April but it feels crappy to have this dropped on me without any outreach)

The report said no symptoms but I have experienced a flipping in my chest and a slight slight cough when I feel that. I brought this to my PCPs attention about 2 years ago and all she did was listen to my chest and say she thought they were PAC and not afib ( my concern then)

I'm definitely going to persue this..

I always thought my bradycardia was from being aerobically fit.. qualified for nationals in 40 k time trail..this is all so disconcerting. 

I remember when I was @19 I went to a dr for something unrelated and he had me do sit ups because my hr was 40. he said he wanted to see if I had a block. It went to 60. 

One thing of note is I was treated for Lyme's disease in the early 90s. I read it could be a factor. But I'm also reading  mobitz 2 resolves with treatment???

My Emergency Department EKG showed probable enlarged left atrium. I'm scheduled for an echocardiogram in late April. Is an enlarged left atrium connected to Mobitz 2?

Last questions..am I going to be able to paddle board, lift weights ( I use one of those Chuck Norris contraptions and kettle bells) and bike if I have a pacemaker??? I also like to plank. 

I appreciate all of your responses so so much. 

I'm happy to have found this site. 

2nd Degree heart block.

by AgentX86 - 2022-02-27 16:26:22

I see that you're in California.  There is no reason to have to wait until April to get an echo, nor is it the most important thing now, in my non-physician opinion. An enlarged left atrium could be caise of your block but the first thing to do is make sure you're protected from pauses. 

You're sure they said Mobitz-1?  Both Mobitz 1 and 2 are catagorized as second degree heart block.  Mobitz-1 is likely to correct itself and, yes, it's not unusual for Lyme to cause Mobitz-1. After twenty something years it should no longer be a problem.

40bpm is way low even for a fit person.  Fifty, I would expect from a competetive athlete but not a lot lower. Bradycardia is anything below 60 so that distinction makes it a pretty lame description.  "Normal" is 60 so if you put a one sigma  edges of the distribution would go down quite a bit.

If you do need a pacemaker make sure that you discuss your lifestyle with your surgeon.  Not all pacemakers are designed equal. Because you seem to have a normal sinus node the type of pacemaker probably won't be significant but make sure you have your needs known.

thanks all

by zanyn7507 - 2022-03-01 23:17:49

thank you for all your responses. I am seeing a cardiologist on Thursday and will update. 

Appreciate everyone's input and time. 

Susannah

Cardiology appt follow up - relieved.

by zanyn7507 - 2022-03-03 15:24:08

.cardiologist says he sees a slight prolongation of pr indicating it's not mobitz 2..that it's athletic heart and that its probably a more benign mobitz 1. he's sending the holter results to an electrophysiologist. 

relieved 

thanks and I'll post an update. 

agentx86 resting hr.

by zanyn7507 - 2022-03-03 15:31:07

my holter does show 47 for resting hr..my garmin shows between 45-53 depending on how conditioned I am and how much sleep. I've had hr monitors forever... perhaps my young age of training long endurance bike rides and racing made my heart more efficient?? 

so just now hoping it's a more benign issue of mobitz 1. 

Take care

electrophysiologist report

by zanyn7507 - 2022-03-03 18:31:03

says it's AV block Mobitz 1 type 2 Wenckebach so nothing needed right now. will get an echocardiogram in April..

I thank you all for your input and I'm glad to have had a place to ramble and get information. 

I wish everyone all the best. This site made me see should I ever need a pacemaker life doesn't end. you're all very inspiring. keep on truckin'. 

Susannah

ar vin

by zanyn7507 - 2022-03-04 23:29:04

thanks for sharing your story. I'm glad you are doing so much better.

Thank you for the advice..I do monitor my heart and will keep an eye. I particularly watch hr variability and recovery.