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  #1  
Old 06-04-2011
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EKG Heart block with myocardial infarction management

IN PATIENT WITH

Myocardial infarction plus bradycardia ( mean heart block different types )

when to start Atropin first if failed then pacemaker??

or when to start pacemaker immediately ??

I thought MI with Mobitz type 2 managment will be atropin then if failed pacemaker but according to kaplan no start for pacemaker
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Old 06-04-2011
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according to MTB page 71
all symptomatic bradycardia r Rx 1st by atropine and then pacemaker if atropine not effective
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Old 06-04-2011
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but in kaplan q bank they said

GIVE ATROPIN first if sinus bradycardia or Mobitz type 1 with infarction

if patient with mobitz type 2 or third degree av block go for pacemaker because atropin less effective

because of that i confuse

even i know in notes no ttt needed for mobitz type 1 alone ( not with MI )

mobitz type 2 ( with out MI ) give atropin if failed then pacemaker.
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Old 06-04-2011
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Correct Answer

Asymptomatic sinus bradycardia, first degree, mobitz type 1 need no treatment.
Symptomatic need atropine, and then pacemaker if no improvement.

Asymptomatic mobitz type 2 and 3rd degree block need a pacemaker, even in the absence of symptoms.
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Old 06-04-2011
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Quote:
Originally Posted by mle guy View Post
Asymptomatic sinus bradycardia, first degree, mobitz type 1 need no treatment.
Symptomatic need atropine, and then pacemaker if no improvement.

Asymptomatic mobitz type 2 and 3rd degree block need a pacemaker, even in the absence of symptoms.

what you mean by symptomatic ? do you mean stable or unstable?
thanks very much
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Old 06-05-2011
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Quote:
Originally Posted by kemoo View Post
what you mean by symptomatic ? do you mean stable or unstable?
thanks very much
yes symptomatic :stable
asymptomatic unstable

Last edited by mle guy; 06-05-2011 at 02:30 AM. Reason: typo
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Old 06-05-2011
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even in 3rd degree block and Mobitz 2 block we START with atropine, knowing that we would need pacemaker ... thats how it is, although i never understood why we shouldnt immediately put pacing
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Old 06-05-2011
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Originally Posted by docoftheworld View Post
even in 3rd degree block and Mobitz 2 block we START with atropine, knowing that we would need pacemaker ... thats how it is, although i never understood why we shouldnt immediately put pacing
Yes that makes sense, because giving the drug is much faster than inserting a pacemaker, even if its transvenous. Right?
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Old 06-05-2011
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honestly, i have no clue what USMLE people wants ...
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