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Symptomatic bradycardia — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsSymptomatic bradycardiaSCE Acute Medicine

An 82-year-old man collapses on the ward. ECG shows complete heart block with ventricular rate 32/min. Blood pressure is 84/48 mmHg and he is confused. He has taken no beta-blocker or rate-limiting calcium-channel blocker. What is the most important immediate action?

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Correct answer: E — Give atropine and prepare for transcutaneous pacing

Complete heart block with hypotension and confusion is an unstable bradyarrhythmia. Atropine may be attempted while preparing pacing and expert help. Amiodarone and adenosine are tachyarrhythmia treatments and would be inappropriate. The pearl is to prepare pacing early when adverse features accompany bradycardia.

Reference: Resuscitation Council UK ALS