A 70-year-old man develops bradycardia and hypotension 8 hours after an inferior STEMI. ECG shows P waves occurring at a rate of 80/min with QRS complexes at 36/min. P waves bear no consistent relationship to QRS complexes. QRS duration is 0.08 sec. What is the most appropriate immediate management?
- A Intravenous atropine 0.5 mg bolus
- B Intravenous amiodarone infusion
- C Immediate temporary transvenous pacing ✓
- D Urgent DC cardioversion
Correct answer: C. Immediate temporary transvenous pacing
Explanation
Complete (third-degree) AV block complicating inferior STEMI presents with AV dissociation, narrow QRS escape rhythm (junctional), and rate around 36/min as seen here. Although atropine may transiently increase rate in junctional block due to inferior MI, it is unreliable. Temporary transvenous pacing is indicated for hemodynamically significant complete heart block post-MI. This block usually resolves within days to weeks with successful reperfusion.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.