Question

An 80-year-old woman presents to the emergency department with dizziness. She now states she is asymptomatic after walking around. Her blood pressure is 102/72 mm Hg. She is alert and oriented. Her lead II ECG is above. After you start an IV, what is the next action?

(3rd degree heart block)

Answer 1

In the case of a third-degree heart block, emergency treatment includes monitoring and, if necessary, transvenous or external pacing, with permanent pacemaker installation as definitive treatment.

Step-by-step explanation:

Managing Third-Degree Heart Block

A third-degree heart block, also known as a complete heart block, is a serious cardiac condition where there is a complete disconnection between the atrial and ventricular electrical activity, as indicated by the absence of correlation between P waves and QRS complexes on an ECG. In an 80-year-old woman with a history of dizziness now asymptomatic with blood pressure of 102/72 mm Hg and a diagnosed third-degree heart block, the next steps after starting an IV can be critical. The initial approach would typically involve close monitoring; however, if the patient is stable and asymptomatic, temporary pacing may not be immediately required. But if any signs of hemodynamic instability appear, emergency transvenous pacing or the use of external pacing may become necessary while awaiting evaluation by a cardiologist for a permanent pacemaker, which is the definitive treatment for this condition.

Patients with third-degree heart block are at risk for sudden cardiac arrest, therefore it is important to have a resuscitation plan in place.