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Complete heart block — SCE Acute Medicine MCQ

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EasyAcute Cardiac PresentationsComplete heart blockSCE Acute Medicine

A 67-year-old man presents with acute chest symptoms with haemodynamic concern. Relevant history includes cardiovascular risk factors or structural heart disease. On assessment, haemodynamic findings and ECG changes are present. Investigations show complete AV dissociation with broad escape rhythm and syncope. What is the most appropriate next step in management?

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

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Correct answer: B — Give atropine if appropriate and arrange urgent pacing

The key discriminator is that complete AV dissociation with broad escape rhythm and syncope, which makes Give atropine if appropriate and arrange urgent pacing the single best answer. Arrange urgent CT imaging is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent specialist referral would fit a different presentation or later stage of care. Optimise chronic medication and discharge and Give analgesia and antiemetic therapy are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: Resuscitation Council UK ALS