Journal of the College of Physicians and Surgeons Pakistan 2011, Vol. 21 (12): 769-771 769 INTRODUCTION In the geriatric population, trauma after falling should be considered a result, and the primary reason such as anemia, arrhythmia, hypoxia, hypoglycemia and drugs should be investigated. 1-3 Atrioventricular (AV) block, is defined as slowing down or blockade in electrical activity that starts from the Sinoatrial node and innervates ventricular muscles by passing through the Atrioventricular node. There are three types of AV blocks; first-degree, second-degree (Mobitz type-I and type-II), and third-degree AV blocks. 4 A Mobitz type-II second-degree atrioventricular block was detected in a woman with multiple rib fractures after falling which drew attention to the cardiac problems that led to trauma in the geriatric population. CASE REPORT A 78-year-old female was referred to our hospital with a diagnosis of rib fractures after falling. Past history included 16 years of treatment of coronary artery disease, hypertension, and type-II Diabetes mellitus. The patient was regularly using Metoprolol succinate, Isosorbid-5-mononitrate, Acetylsalicylic acid, and Acarbose. On physical examination, she was conscious. Her arterial blood pressure was 60/30 mmHg, and heart rate was 30 bpm. Both hemithoraxes were participating in the respiration, and there was tenderness in palpation of the right hemithorax. Laboratory findings were haemoglobin level 11.2 g/dl and blood glucose level of 132 mg/dl. An electro- cardiogram (ECG) revealed Mobitz type-II second- degree atrioventricular block (2:1; Figure 1). So, Atropine 0.5 mg was started intravenously. The same dose was given to the patient every 3 minutes due to a lack of response, for a total dose of 3.0 mg. However, there was no change in rhythm, so a transcutaneous external pacemaker was inserted in the emergency room, immediately after which a temporary transvenous pacemaker was inserted in the catheter angiography unit. The patient's pulse increased to 75 bpm (Figure 2) and arterial blood pressure to 90/60 mmHg. In addition, a chest roentgenogram showed non-complicated fractures in the right 6th, 7th, and 8th ribs (Figure 3). Without β-blocker treatment, she had an average heart rate of 65 bpm and normotensive blood pressure on the 4th day so the pacemaker was removed. Efficient analgesia was performed for the rib fractures. The patient was generally healed and was discharged. She remained asymptomatic at a 3 months follow-up. ABSTRACT Cardiac rhythm problems are frequently seen in the geriatric population, and they can experience trauma after syncope. A 78-year-old female was examined for thoracic trauma after falling. With a history of β-blocker use, arterial blood pressure measured 60/30 mmHg and pulse rate was 30 bpm. Electrocardiogram showed a Mobitz type-II second-degree atrioventricular block. There was no response to atropine, so a transcutaneous external pacemaker and after that a transvenous pacemaker were applied. On the 4th day, the pacemaker was removed and the patient was discharged. Key words: Geriatrics. Thoracic injuries. Rib fractures. Atrioventricular block. Adrenergic beta-antagonists. Pacemaker. Department of Emergency Medicine 1 /Chest Surgery 2 /Cardiology 3 , Duzce University Medical School, Duzce, Turkey. Correspondence: Dr. Sami Karapolat, Menderes Cadd, No: 52/8, Buca, Izmir, Turkey. E-mail: samikarapolat@yahoo.com Received November 12, 2010; accepted October 12, 2011. A Rare Cause of Trauma in the Elderly: Mobitz Type-II Second-Degree Atrioventricular Block Hayati Kandis 1 , Sami Karapolat 2 , Ismail Erden 3 , Melik Candar 1 and Ayhan Saritas 1 CASE REPORT Figure 1: First patient ECG: Mobitz type-II second-degree atrioventricular block (2:1).