sunny2
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Which of the following patients has an indication for permanent pacemaker placement?
A. Tatyana Toxoplasma shivchenenko,a 25-year-old female with a history of recurrent idiopathic syncope is noted to have a heart rate of 65 on physical exam. An electrocardiogram shows sinus rhythm at 65. Carotid sinus massage results in 4-s ventricular asystole with presyncope.
B. Yurikosuria gagerin, a 57-year-old male has an inferior myocardial infarction complicated by a Mobitz type II second-degree block with a narrow QRS complex. After emergent percutaneous intervention the patient feels well. The electrocardiogram shows sinus bradycardia with a heart rate of 50 while the patient is taking low-dose metoprolol.
C. Olga Syphilitic Zostrovna ,a 75-year-old female with no symptoms. Electrocardiography shows first-degree atrioventricular block and right bundle branch block.
D. Valerie Candida Lymphoma, a 65-year-old asymptomatic male referred for Holter monitoring before obtaining a life insurance policy. He is found to have intermittent third-degree atrioventricular block.
E. Hodgkin Lymphocytic kirkorov, a 29-year-old male with acute Lyme disease is noted to have syncope with third-degree heart block. After treatment, electrocardiography shows sinus rhythm at 55.
Edited by sunny2 on 10/05/06 - 04:22 PM. Reason: too many choices
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| saadtazjam
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H?
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| sunny2
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Saadtazjam.... H was not the correct answer,
To make the question easy, I have eliminated all the incorrect choices from F to J .
Now , guess 
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| saadtazjam
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D?
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| sunny2
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It seems, nobody wants to be a cardiologist ....
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| study_ing
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B and D..
E shud be treated and it will improve. hence we need to wait before a permanent pacemaker.
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| sunny2
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saadtazjam ,
Choice - D is the second most common Incorrect answer and
study_ing,
Choice -B is the first most common Incorrect answer
Now guess from the remaining
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| study_ing
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a is symptomatic so y not 
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| sunny2
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There you go
A is Correcto
In this case, it is of note that patients with supranodal third-degree heart block that resolves do not require permanent placement. Further, asymptomatic atrioventricular block with associated fasicular block does not warrant pacemaker placement. Additionally, asymptomatic intermittent third-degree atrioventricular block is a class III indication for a pacemaker. Patients with Lyme disease–associated third-degree block generally are reversible with antibiotic therapy, in which case a permanent pacemaker is not indicated. Carotid sinus hypersensitivity syndrome is defined as a greater than 3-s ventricular asystole after carotid sinus massage. Patients with this syndrome who have recurrent syncope warrant permanent pacemaker placement. Of note, many elderly patients also have ventricular asystole greater than 3 seconds without symptoms. In these patients pacemakers are not always indicated.
study_ing, I am having a fun time with getting these questions wrong, I hope and pray to God not to give me this type of fun in the real exam
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| study_ing
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my prayers are with u
thanx
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