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Symptomatic bradycardia — DIPIMC MCQ

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HardMedical EmergenciesSymptomatic bradycardiaDIPIMCDipIMC

A 78-year-old is dizzy and clammy with a heart rate of 38 per minute and a systolic blood pressure of 82 mmHg. The ECG shows complete heart block. He has received atropine 500 micrograms intravenously with little response. What is the most appropriate next step?

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Correct answer: B — Provide transcutaneous pacing while preparing for transvenous pacing

Bradycardia with adverse features (hypotension and presyncope) and complete heart block that does not respond to atropine should be managed with transcutaneous pacing while arrangements are made for transvenous pacing and specialist care. Repeat atropine is often ineffective in high-grade block, and adenosine would worsen the bradycardia. Routine referral is unsafe in an unstable patient. Pearl: while preparing pacing, an adrenaline infusion can be used as an interim measure if pacing is delayed.

Reference: Resuscitation Council UK Guidelines 2025 (Peri-arrest Arrhythmias); JRCALC Clinical Guidelines