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*Optimal management in these patients remains unclear.

*Optimal management in these patients remains unclear.

patients treated with beta-blockers, but this complication was not specifically reported in many of the studies. Trials of thrombolytic therapy have suggested that the frequency of clinically significant AV block may be somewhat lower than in the pre-reperfusion therapy era.

First-Degree and Mobitz I (Wenkebach) Second-Degree AV Block

First-degree AV block (see Fig. 19) occurs in 7-13% of patients with AMI; Mobitz I block (see Fig. 20) occurs slightly less frequently (123). More common in IMI than anterior MI, these conduction abnormalities frequently reflect increased vagal activity at the AV node. Marked first-degree AV block (PR interval >0.24 s) is a relative contraindication to beta-blocker therapy; in less severe cases, the PR interval should be monitored and the dose of beta-blocker therapy held or reduced if progressive PR prolongation occurs. Mobitz I block (see Fig. 20) is generally-well tolerated in the setting of IMI; patients with hemodynamic compromise generally respond to atropine. The presence of low-grade AV block does not seem to affect prognosis.

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