The Correct Answer is C!


A 55-year-old woman presents with an inferior STEMI for which she had primary PCI. In the cath lab, she had multiple episodes of 2:1 AV block with sinus bradycardia. She now returns to the CCU with a BP 90/60 and intermittent 2:1 and 3:2 AV block, and had several episodes of complete heart block with a narrow complex escape at 52 bpm, all asymptomatic.

What is the best management approach?

A. Insert TPM via internal jugular
B. Atropine followed by isoproterenol drip
C. Apply transcutaneous pacing pads and observe
D. Place DDD PPM


Patients with conduction disease during an acute MI are managed according to the type of block and the location of the infarction. Patients with an inferior MI and transient heart block can be observed as long as they remain asymptomatic since the level of the block is usually at the AV node with a good escape rhythm and is temporary, caused by high vagal tone.


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