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Complete heart block after anterior myocardial infarction — SCE Acute Medicine MCQ

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HardCardiovascular medicineComplete heart block after anterior myocardial infarctionSCE Acute Medicine

A patient taking flecainide presents after an overdose with hypotension, QRS duration 190 ms and recurrent broad-complex ventricular arrhythmia. What is the toxin-directed treatment?

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Correct answer: D — Give sodium bicarbonate guided by ECG response

The best answer is “Give sodium bicarbonate guided by ECG response”. This is correct because flecainide causes severe sodium-channel blockade, producing QRS widening, ventricular dysrhythmia and shock. Sodium bicarbonate supplies sodium and alkalinises plasma to reduce drug binding, with repeated ECG and pH assessment. Calcium, magnesium and amiodarone do not directly reverse this mechanism, and delayed oral decontamination cannot treat established cardiovascular toxicity.

Reference: Resuscitation Council UK special-circumstances guideline: https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/special-circumstances-guidelines