79 yo F is seen for dizziness of 2 months duration. HR is 32-40. EKG is as below. 

Repeat EKG is shown here.

What is the diagnosis?
  • Second degree Type 2 
  • Third degree block 
Second degree. For third degree, QRS will be independent of p wave. Here, all q wave have preceding P wave. 

Third degree heart block demonstrating the above description. 

What is High-grade a-v block?
When there is a skip of 2 or more p -wave being conducted to ventricle, then it is called as high-grade A-V block