Bradycardia

Q1. 65 year old mechanic was electively admitted for OGDS to investigate IDA. His vitals signs are: BP 138/77 HR 49 Spo2 99% on RA. He does not have any symptoms. His ECG is as follows.  What is the next course of action?

• ••Screen for secondary causes

• •Observe the patient

• • 24H Holter monitoring

• Refer for permanent pacemaker insertion

You are called to see a 54 year old patient in Heart Failure clinic with this ECG. Her vital signs are as follows: RR 18 Spo2 96% on RA BP 100/60 HR 55. What is the most significant factor to consider in your initial clinical assessment of the patient?

• Heart rate

• Blood pressure

• Adequate perfusion status

• Glycemic control

 A 60 year old man with u/l dyslipidemia complaining of fatigue and dyspnoea comes to your clinic for a review of his results. His vital sigs His Holter results show the following. What is the most likely diagnosis?

• Chronic obstructive pulmonary disease

• Heart failure with reduced ejection fraction

• Obstructive sleep apnoea

• Ischemic heart disease

Q4. A 71 year old lady with known case of AF on Dabigatran comes to your clinic complaining of palpitations and “skipped beats” sensation and failure symptoms. Her ECG is as follows. What is your diagnosis?

• AF with PVC

• 3rd degree AV block

• AF with slow ventricular response

• Sick sinus syndrome

A 63 year old gentleman with u/l hypertension and T2DM presents to ED with a syncopal attack. What is the likely diagnosis?

• Tachy-brady arrythmia

• Sick sinus syndrome

• Mobitz Type II 2nd degree AV block

• Mobitz Type I 2nd degree AV block

A 57 year old patient presents confused to ED with symptomatic bradycardia with evidence of hypoperfusion. What initial step needs to be taken? 

• •Prepare for transcutaneous pacing

• •Observe and monitor the patient in Resus

• Deliver an unsynchronized cardioversion at 120 Joules

• Administer IV Atropine

According to ACLS protocol, what is the correct dosage of Atropine to be given?

• IM Atropine 0.5mg, repeat every 3-5 minutes, max 3mg

• IV Atropine 0.5mg, repeat every 1 minute, max 5mg

• IM Atropine 1mg, repeat every 1 minute, max 5mg

• IV Atropine 1mg, repeat every 3-5 minutes, max 3mg

Which group of unstable symptomatic bradycardic patients should Atropine be used cautiously?

•I- Myocardial infarction

•II- Post cardiac transplant

•III- High degree AV block

•IV- Hypothermia

• •I & II

• •I, III, & IV

• •II & III

• All of the above

What does this ECG show?

• Single chamber pacemaker

• Dual chamber pacemaker

Which patient would NOT be a suitable candidate for dual chamber pacing?

• 60 yo with sinus node dysfunction

• 59 yo ADL dependent patient with CHB

• 65 yo with u/l AF and HFrEF

• 70 yo with hx of prev stroke presenting with sinus pauses