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Complete heart block — SCE Acute Medicine MCQ

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EasyAcute Cardiac PresentationsComplete heart blockSCE Acute Medicine

A 81-year-old man is assessed on the acute medical unit. He has syncope and a ventricular rate of 28/min. ECG shows complete AV dissociation and atropine has produced no sustained response. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: B — Arrange temporary transvenous pacing urgently

Arrange temporary transvenous pacing urgently is the best answer because symptomatic complete heart block refractory to atropine requires urgent pacing support. Arrange same-day ambulatory follow-up is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Broad QRS escape rhythms are less reliable and need early pacing planning.

Reference: Resuscitation Council UK bradycardia algorithm