There is a Pwave before every QRS, but not a a QRS after every P. This indicates the presence of AV block. There is fixed PR interval, and random "dropped beats". This is second degree AV Block type 2 (so-called Mobitz 2.) The QRS is widened, possibly indicating a concomitant left bundle branch block (but cannot say for certain with only a single lead). There are long pauses present due to the block. Because of risk of progression to complete heart block, and the possibility of syncope due to the pauses, a pacer may well be indicated here.
NOTE: EKG's are for internal educational purposes of the University of Massachusetts Department of Family Medicine. Please do not forward without permission from Dr. Golding!
