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High-risk syncope with bifascicular block — RCPSC EM MCQ

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HardCardiovascular emergenciesHigh-risk syncope with bifascicular blockRCPSC EM

A 70-year-old man presents CTAS 2 with syncope while seated. ECG shows bifascicular block, troponin is normal, and orthostatic vitals are negative. He has no prodrome and injured his face during the fall. What is the most appropriate investigation?

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Correct answer: D — Continuous cardiac monitoring with admission-level rhythm evaluation

Syncope without prodrome plus bifascicular block raises concern for intermittent high-grade AV block. Monitored evaluation is appropriate.

Reference: Royal College Emergency Medicine exam format and training experiences