Mobitz Type 2 in healthy 25yr old male?

[Cheese88]

Hi,
I am young healthy 25 yr old male pretty athletic build. I play soccer once a week sometimes more, work out and lift weights 2-3 x a week.  My resting heart rate is usually 50. I'm a it professional and sit many hours at the computer daily. I recently went to my doctor as I was having skipped beat sensation.(pvcs).  Particularly worse after eating or laying down for bed and they seem to have gotten worse over the years.  So my doc put me on 24/hr holter monitor last Thursday 4/12.  I just spoke with him yesterday with my results. He said my heart looked really good despite occasional pvcs, however, there was one episode of second degree mobitz type 2 (not type 1) and my heart rate was also in low 30s at one point.  He said I should go see a cardiologist to make sure everything is ok.  Well of course, with technology these days I researched the crap out mobitz 2 and I'm pretty scared now. I scheduled a visit to see a cardio this coming week.

I have a few questions:
1. If it truly is mobitz 2 shouldn't the doctors be more worried and get me in faster to see a cardiologist??
2. Is it possible the mobitz 2 was a misreading? They thought at first it was a mobitz 1..
3. Is it possible that medication such as a PPI/pantoprazole causes my extremely low heart rate and the mobitz 2? I say this because I always have bad heart palps and irregular heart beats when I take ANY PPIs for GERD and when I stop taking them the palp severity is gone instantly. I made sure to take one the day of the holter test.
4. I'm afraid something bad is going to happen to me before they actually find out anything...

Please help.  Thank you.

[slegendlewis]

Hey, how is everything now??

I am pretty much in the exact same position as you and I am too fit and only 34.

It's totally normal in healthy people to have these blocked beats in your sleep so don't worry! The skipped beats are seriously just anxiety so that's the issue here! Hope all is well.

Steve

[is_something_wrong]

It depends on when you had the Mobitz 2. If you had it at daytime and feeling about to faint, it's not normal. Mobitz 2 is fairly normal at night, especially in people with slow heart rate (like you).

To answer your questions:

1. Depends on when, as mentioned. Mobitz type 2 at night is usually a normal finding. Of course, it also depends on the frequency. If you only had a few blocked beats, it's less severe than almost going into total block (3rd degree).

2. Mobitz type 1 has a very typical pattern (gradually prolonged PR interval until one beat is blocked, then return to normal, and repeat). I can't say what your doctor has done, and I'm not a doctor, but it sounds unlikely.

3. No, not likely. Of course, anything is possible, but I've never heard about it.

4. If you don't have symptoms at daytime, it's very unlikely anything bad. The heart does a lot of weird stuff at night, and the "normal" ranges are very wide. Even runs of escape rhythm can be seen normally at night. And the better your condition is, and the slower your heart rate is, more weird stuff can the heart do. As my cardiologist said; "if someone knew all the things the heart might do during sleep, they would likely not dare to sleep".

[Cheese88]

Thank you so much for taking the time to respond. I feel a little better now.  I'm pretty sure the mobitz 2 was seen during sleep.  I have had occasional bouts of chest pain, shortness of breath in middle of night, and rarely sometimes random feelings of very slight dizziness. But I'm pretty sure the chest pain and SoB is caused by my GERD. The dizzines feelings is most likely anxiety.

[Csizi]

Hi! I have a similar case now and I was wondering what is the end of the story of yours. Did you get a PM? Was it actually a Mobitz II(A non-conducted PAC can be misdiagnosed to a Mobitz II)?  If you have anxiety and GERD (the two things we have in common) its more likely to be a Mobitz I that a bit looks like a Mobitz II but misdiagnosed?

According your questions:

1. Yes he should be worried if there is no underlying cause such as a lyme disiease or hyperkalemia (high potassum).

2. Definitely possible (actually all Mobitz 2 are a Mobitz 1 but with very small increase in the PR distance, and non-conducted PACS or other stuff can actually look like a Mobitz. If you have Mobitz 2 you should react badly to excercise. Mobitz 2 is a rare thing for someone with no heart issue and young, only if you are an elit athlete.
3. Dont know, sorry:(
4. I have read the even if a Mobitz 2 can advance to a 3rd type AV block or to an advanced second degree AV block, you propably gonna feel it (you might faint or have really uncomfortable dizziness and light-headedness and chest pain). The point here is, if you have a temporary Mobitz 2 (which is the case mostly, intermittent Mobitz 2 is less common as I understood), so its not only one beat missing but more with a set of rhythm, you will feel bad, and you will have low heart rate, then you should call 911 ASAP. Its unlikely, but I think you gonna make it to the emergency before anything bad could happen to you since your heart is actually healty and capable of handling a short period of AV block. Its only life-treathaning if you don't get a PM the first time you have a serious period of Mobitz 2.

Im not a doctor, neither a cardiologists, but this is my take on the story, after having similiar symptoms like you and having consulted with actual doctors.