ECG Quiz 1. An Electrocardiography Case. A Patient With Weakness and Dizziness

An ECG quiz. What is the diagnosis and which should be the proper management ?
The answer has been posted here (see below) and it will also be included with more details in a next video.
THE ANSWER
Heart rate (ventricular rate) 30- 35/min. P waves are more frequent than the QRS complexes and they do not have any temporal relation with QRS complexes (some P waves even fall in the ST segment). This is a case of complete atrioventricular block. QRS has a right bundle branch block morphology. In general, complete atrioventricular (AV) block would be an indication for permanent pacing, but in this case the complete (third degree) AV block could be possibly caused by verapamil, which the patient has been taking for hypertension. So there is a potentially reversible cause for the AV block. When we suspect a reversible cause we do not implant a permanent pacemaker. Instead there is an indication for temporary pacing and discontinuation of the causal drug. The patient was admitted to the hospital, verapamil was discontinued and replaced by another antihypertensive agent, which has no effect on conduction. The patient remained under observation with temporary transvenous pacing for 2 days. Two days after the discontinuation of verapamil the normal heart rhythm and the normal atrioventricular conduction recovered. So a permanent pacemaker was not implanted. In cases that the complete AV block persists and is not reversible, or if there is no revesible cause for the block, then implantation of a permanent pacemaker is indicated.