# Mobitz II vs Mobitz II Advanced.....



## RanchoEMT (May 23, 2011)

I've searched this site but was unable to find anything on the different types of 2° Type II AV Blocks... My ECG Class Instructor is stating that there are 2 Types of 2° AV Block Type II's...(Confused Yet..) So Let's Forget about "Mobitz I/Wenckebach" and focus on different types of Mobitz II. *My Instructor states there is Mobitz II and Mobitz II ADVANCED(2:1)*... Is this just a constant Mobitz II Atrial/Ventricular ratio???

My ECG Class Book(http://www.amazon.com/EKG-Plain-Simple-3rd-MyHealthProfessionsKit/dp/0132377292) (pg. 152)of what it states, it states un-clearly.

--BLOCKS--
*1° AV Block* - Prolonged PR Interval (Wider .12sec)
*Bundle Branch Block* - Wide QRS Complex (Wider than .20sec)
*2° AV Block Type 1* aka "*Mobitz I*" or "*Wenckebach*" - PR Interval Gradually Becomes Wider Until there is a Dropped QRS

*2° AV Block Type 2* aka "*Mobitz II*"- ????
*2° AV Block Type 2 Advanced* aka "*Mobitz II Advanced*"-????

*3° AV Block* - Complete Atrial/Ventricular Dissociation


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## jgoodfernandez (May 23, 2011)

A block involving 2 or more consecutive sinus P waves are sometimes referred to as high-grade AV block. In high-grade AV block, some beats are conducted in contrast to third-degree AV block. 
high grade AV block could be the same as Mobitz II advanced


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## Aprz (May 23, 2011)

Recall that that with 2 degree AVB, one _or more_ QRS complex can be dropped in a row. So if every other complex is dropped (one p-wave with a compex followed by another p-wave without an associated complex, and it repeats), this is called 2:1 block. You cannot distinguish between Wenckebach or Mobitz because you cannot see the PRi gradually increase or not. However, as more compexes are dropped e.g. 3:1 (one p-wave with a complex followed by 2 more p-waves with an associated complex), 4:1 (one p-wave with a complex followed by three p-waves without an associated complex), ..., etc, this is called advanced Mobitz block.







Forgive my poor drawng, those are not P', and that's not a delta wave in the second complex, haha, but that's an example.

*Edit:* By the way, I believe Mobitz/Type I and Mobitz/Type II were dropped in favor of just saying Wenckebach and Mobitz.


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## RanchoEMT (May 23, 2011)

jgoodfernandez said:


> A block involving 2 or more consecutive sinus P waves are sometimes referred to as high-grade AV block. In high-grade AV block, some beats are conducted in contrast to third-degree AV block.
> high grade AV block could be the same as Mobitz II advanced



Is this what is meant when referring to AV Blocks as 2:1,3:1,4:1,etc, AV Blocks?


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## RanchoEMT (May 23, 2011)

Aprz said:


> Recall that that with 2 degree AVB, one _or more_ QRS complex can be dropped in a row. So if every other complex is dropped (one p-wave with a compex followed by another p-wave without an associated complex, and it repeats), this is called 2:1 block. You cannot distinguish between Wenckebach or Mobitz because you cannot see the PRi gradually increase or not. However, as more compexes are dropped e.g. 3:1 (one p-wave with a complex followed by 2 more p-waves with an associated complex), 4:1 (one p-wave with a complex followed by three p-waves without an associated complex), ..., etc, this is called advanced Mobitz block.


Sorry, responded to the previous post before your post came through. So it is





RanchoEMT said:


> just a constant ------- Atrial/Ventricular ratio???






Aprz said:


> *Edit:* By the way, I believe Mobitz/Type I and Mobitz/Type II were dropped in favor of just saying Wenckebach and Mobitz.



Holli Flogn' LuYa! I wasn't gonna use that 2 degree type II  :censored::censored::censored::censored: in the field anyways. ha! So there is wenkebach, Mobitz II, and Mobitz Advanced(2:1,3:1,4:1,etc)?


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## Aprz (May 23, 2011)

No Mobitz II, just simply Mobitz, mwhahaha.

Yeh, pretty much. It's a collective description to second dregree Mobitz.


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## RanchoEMT (May 23, 2011)

Aprz said:


> No Mobitz II, just simply Mobitz, mwhahaha.
> 
> Yeh, pretty much. It's a collective description to second dregree Mobitz.


ko0L.

Now what is actually going on physiologically in the heart that causes an 'Advanced AV Block' with a consistent ratio as opposed to a regular Mobitz?


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## the_negro_puppy (May 23, 2011)

RanchoEMT said:


> I've searched this site but was unable to find anything on the different types of 2° Type II AV Blocks... My ECG Class Instructor is stating that there are 2 Types of 2° AV Block Type II's...(Confused Yet..) So Let's Forget about "Mobitz I/Wenckebach" and focus on different types of Mobitz II. *My Instructor states there is Mobitz II and Mobitz II ADVANCED(2:1)*... Is this just a constant Mobitz II Atrial/Ventricular ratio???
> 
> My ECG Class Book(http://www.amazon.com/EKG-Plain-Simple-3rd-MyHealthProfessionsKit/dp/0132377292) (pg. 152)of what it states, it states un-clearly.
> 
> ...



Just a correction QRS complexes should be less than .12, and P-R interval shoudl be 0.2 or less, i think you had them backwards


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## RanchoEMT (May 24, 2011)

the_negro_puppy said:


> Just a correction QRS complexes should be less than .12, and P-R interval shoudl be 0.2 or less, i think you had them backwards


oops. Your Right, bass ackwards.. 2 Gold Stars to you **


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## Aprz (May 24, 2011)

Hey! Where are my gold stars?!

As for as consistency, I don't see why it would be any different from any other rhythm. As the block progressively gets worse, less conduction gets through, and it eventually advances to third degree AVB once the ventricles begin to escape.


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## RanchoEMT (May 24, 2011)

Aprz said:


> Hey! Where are my gold stars?!



Well everybody can have gold stars. Thats a very mediocre commodity. Every lowly pusillanimous EMT that crawls into a ford Leader or slinks through kindergarten  has accumulated gold stars on a wall somewhere in some point in time. Back where I come from we have universities, seats of great learning, where men go to become great thinkers and when they come out they think deep thoughts and with no more gold stars than you have. But! they have one thing you haven't got...


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## Aprz (May 24, 2011)

RanchoEMT said:


> Well everybody can have gold stars. Thats a very mediocre commodity. Every lowly pusillanimous EMT that crawls into a ford Leader or slinks through kindergarten  has accumulated gold stars on a wall somewhere in some point in time. Back where I come from we have universities, seats of great learning, where men go to become great thinkers and when they come out they think deep thoughts and with no more gold stars than you have. But! they have one thing you haven't got...


Money and maybe a job?

*Edit:* and somebody was too scared to say...


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## RanchoEMT (May 24, 2011)

Aprz said:


> Money and maybe a job?
> 
> *Edit:* and somebody was too scared to say...



yeah, ....something to the effect of an adequate paycheck and viable lifestyle.... EMS sucks.


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## RanchoEMT (May 24, 2011)

all in good humor tho my friend. Thanks for the discussion.


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