The electrical pulse of the normal heartbeat begins inThe SA node.

The current then runs along tracts to the AV node.

2nd degree heart block Type II or Mobitz II is sometimes intermingles with a type I. The major difference to look for is that the PR interval stays the same width but there are dropped QRS complexes. Remember in the story, this is when Penny doesn't try to get closer to Quinton anymore, when he is there they are the same width apart but he often does not come home. There is no pattern to see the drop coming. As you can imagine, this particular rhythm can lead quickly to low cardiac output and especially to a 3rd degree or complete heart block because the communication is not very good. Many times the type I and type II heart blocks coincide and indicate a worsening in condition. This heart block can lead very quickly to V-tach and/or V-fib. While this rhythm alone is not lethal, it does need to be acted on to prevent further decline.What do you do?Assess the patient to see if there is adequate perfusion. Does the patient feel the heart beating strangely? What is the rate? Has urinary output decreased recently? Is the skin warm and dry, or cool and clammy? Obtain an EKG and call the M.D. for further orders. Anticipate a cardiology consult if no cardiologist on the case. Have current labs available. Check O2 sat if patient is not on continuous to make sure patient is getting proper oxygen. Remember, poor perfusion can increase the chances of clots and ischemia which can lead to strokes and myocardial infarctions.

2nd degree AVHB Mobitz II