Sun31October0735PM 7

A 58-year-old lady presents feeling light headed and breathless. She has a history of ischaemic heart disease.

On examination she looks pale and clammy. Her heart rate is 40 /min, blood pressure 80/50 mmHg, capillary refill time (CRT) is 4 seconds. An ECG shows a Mobitz type II AV block.

You administer aliquots of atropine to a maximum of 3 mg, but the blood pressure remains 80/50 mmHg and she is now mildly confused.

Which of the following would be the most appropriate management?

(Please select 1 option)

Transcutaneous pacing

Isoprenaline infusion

Adrenaline infusion

Dopamine infusion

Transvenous pacing Correct

Explanation

All of the above options are suitable to manage a symptomatic bradycardia. However, if transvenous pacing is available to you with a competent operator inserting the wire, then this would provide the most stable line of management until the underlying cause is treated or a permanent pacemaker is implanted.

Transcutaneous pacing is always an option in the immediate term as a holding measure. However it is painful for the patient and so not it is advisable to transcutaneously pace an individual for any great length of time.

All the other methods are second line management if transvenous pacing is not available. Indications for temporary transvenous pacing may include:

Ventricular standstill >3 seconds

Mobitz type II AV block

Complete heart block

Extreme bradycardia with heart rate <40.

Answer Statistics

1

47%

2

17%

3

5%

4

33%

Times answered: 288