What are your thoughts? Does she need a PM? Admission?
I thought this was tricky because it would be easy to call this CHB.
This is really just a 1° AVB. What you're seeing is a junctional escape (40bpm) rhythm producing a repeated dysrhythmic sequence of two junctional excapes and a ventricular capture. There is no BBB, there are subtle differences in the QRS "escape complexes" (vs the captured ones) . The captured beats tell us that if her sinus rate dropped to about 60, she would have 1:1 conduction.