Woman’s Pain is Per-cyst-ent

ANSWER

The correct interpretation includes sinus tachycardia with second-degree type 2 (Mobitz II) block, 2:1 AV conduction, and a right-axis deviation.

The P-P interval is 100 beats/min—twice the rate of the QRS complexes. A consistent PR interval > 200 ms supports the diagnosis of first-degree AV block, as the ratio of two P waves for every QRS does for 2:1 AV conduction. Finally, a right-axis deviation is evidenced by an axis > 90°.

These findings are suggestive of AV nodal disease and may explain the patient’s recent increase in fatigue (noted in the review of systems).