skip to main content

Arrhythmic syncope — MCCQE Part 1 MCQ

Instant feedback + full explanation. One question, done properly.

HardSyncopeArrhythmic syncopeMCCQE Part 1

68-year-old man with prior myocardial infarction presents with syncope while walking. There was no prodrome; ECG shows bifascicular block. Which of the following is the most appropriate next step?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Arrange urgent cardiac monitoring and specialist assessment

Arrange urgent cardiac monitoring and specialist assessment is best because syncope without prodrome in structural heart disease and conduction disease suggests arrhythmic syncope. Discharge after a single normal initial test is suboptimal because early cardiac disease can be missed by one isolated result; Arrange routine cardiology review without acute risk stratification is suboptimal because routine referral is too slow for a potentially unstable presentation; Give reassurance because the patient is young or previously well is suboptimal because age alone does not exclude serious cardiovascular disease; Treat only the symptom and omit ECG or biomarker-based assessment is suboptimal because cardiac presentations require objective assessment when suggested clinically. High-risk syncope is admitted or urgently assessed even if the patient now looks well.

Reference: CCS Syncope Guideline 2020