ACLS Bradycardia 4

Question 1

A patient with an inferior STEMI develops bradycardia. What is the most likely underlying conduction abnormality?

Accepted Answer

AV block at the level of the AV node

Answer

Inferior MI commonly causes AV nodal ischemia (right coronary artery supplies the AV node in most people), leading to nodal-level AV block.

Question 2

During transcutaneous pacing, the patient is conscious and experiencing significant discomfort. What should the provider do?

Accepted Answer

Administer IV analgesia and sedation

Answer

Analgesics and sedatives should be administered to manage pain and anxiety during transcutaneous pacing in conscious patients.

Question 3

Which ECG feature distinguishes a junctional escape rhythm from a ventricular escape rhythm in complete heart block?

Accepted Answer

Width of the QRS complex

Answer

Junctional escape beats produce narrow QRS complexes (≤0.12 sec), while ventricular escape beats produce wide QRS complexes (>0.12 sec).

Question 4

A patient with symptomatic bradycardia has a known transplanted heart. Why might atropine be ineffective?

Accepted Answer

The donor heart is denervated and lacks vagal innervation

Answer

The transplanted heart is denervated and does not respond to atropine because there is no vagal innervation to block.

Question 5

What pacing rate is typically used as an initial setting when starting transcutaneous pacing for bradycardia?

Accepted Answer

60–80 bpm

Answer

An initial pacing rate of 60–80 bpm is typically selected to achieve hemodynamic stability in bradycardic patients.

ACLS Practice Test