Bradycardias – Post Test

Which one of the following is the most important consideration when deciding how urgently to treat a bradycardia?

Which one of the following is the first line drug treatment for symptomatic bradycardia?

A 75-year-old man presents with syncope and on examination is found to be in complete heart block. When recumbent he is asymptomatic with a blood pressure of 105/70. He has no signs of respiratory compromise and arterial blood gas analysis is normal.

Which one of the following actions should be taken?

A 50-year-old woman presents with a first episode of collapse when getting out of bed in the middle of the night. She has now recovered but tells you that she has recently started Atenolol 50 mg o.d. for hypertension and says she has felt dizzy and tired since. Her ECG shows a sinus bradycardia of 50 with a lying BP of 125/70 and standing BP of 110/65. The rest of the examination is normal and she is not on other medication.

Which one of the following would be an appropriate course of action?

A 65-year-old man presents with sudden collapse just before crossing a road with gradual recovery by the time of arrival at the ED. He has a normal examination and ECG is normal. He says that this has happened before when turning his head suddenly or wearing his tie too tight. His only medication is thyroxine. The ambulance crew gives you a rhythm strip during which he was symptomatic (below).

Fig.13⁷

Which one of the following is the most likely diagnosis?

What does this ECG show?

Fig.14 via LITFL

A 60-year-old man presents with sudden collapse. He was well before this and is known to suffer from hypertension. On examination, he has a GCS of 3, small un-reactive pupils and a BP of 240/135. His pulse is 40 with an ECG showing a sinus bradycardia.

Which one of the following is the most likely cause of his bradycardia?

A 45-year-old woman is brought in to the ED having been difficult to rouse when found sleeping rough. On examination she smells of alcohol and is confused. Her pulse is 45 with a BP of 85/60.

Her ECG is shown below.

Fig.15 via LITFL

Which one of the following is the most likely diagnosis?

A patient presents with breathlessness and a heart rate of 50. His medication includes amiodarone. His ECG is shown below:

Fig.16 via LITFL

What does this ECG show?

A 70-year-old man presents with a syncopal attack. On arrival he has recovered but says that these have been occurring since a water tablet was added to his other medication. He also complains of recent nausea and anorexia. He has an irregular pulse of 55 and BP of 118/70. The rest of the examination is normal.

His ECG is below.

Fig.17 via LITFL

Which one of the following is the most likely cause of his symptoms?