Not so Fast:Acceleration-dependent or Mobitz Type II Second-degree AV Block

Sudden acceleration of the heart rate was a perplexing development in a patient who,for the most part,seemed to be in much better clinical condition than he had been when admitted to the hospital. A 60-year-old man with end-stage chronic obstructive pulmonary disease (COPD) and chronic bifascicular block was hospitalized for an exacerbation of COPD. His heart rate on admission,while receiving beta-adrenergic inhalers,was in the low 60s (A). Two days later,when his presenting symptoms had improved,his heart rate was in the low 100s (B). What was the cause of this paradoxical increase in the heart rate at a time when the patient’s clinical condition had improved? What was the clinical significance of these findings?
The American Journal of Medicine

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