[NBME] 3rd degree AV block

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[NBME] 3rd degree AV block

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fongch
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05/12/07 - 01:28 PM

Personally I pick D (Immediate placement of a pacemaker); however, other think hyperkalemia 2ary to CRF is the cause and therefore B is the next step to take.
Your opinion please.

One day after missing her dialysis treatment, a 27-year-old woman comes to the physician because of generalized weakness. Her blood pressure is 95/72 mm Hg, and pulse is 45/min and regular. Examination shows a well-functioning arteriovenous fistula in the left upper extremity. Muscle strength is 3/5 in all extremities. An ECG shows third-degree atrioventricular block. Laboratory studies are ordered. Which of the following is the most appropriate next step in management?

A ) Kayexalate-sorbitol enema
B ) Intravenous administration of calcium gluconate
D ) Immediate placement of a pacemaker
E ) No treatment pending laboratory results

webjeee
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05/12/07 - 06:04 PM

D probably what is the c

munnabhai MRCS
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05/12/07 - 10:55 PM

May be b.. delay in dialsis can preptt k increase ..which can can cardiotoxicity. IV calcium gluconate is cardioprotective

Edited by munnabhai MRCS on 05/12/07 - 11:57 PM

fongch
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05/13/07 - 10:26 AM

But if hyperkalemia is present, ECG should detect it (hyperacute T wave), right?

munnabhai MRCS wrote:
May be b.. delay in dialsis can preptt k increase ..which can can cardiotoxicity. IV calcium gluconate is cardioprotective

munnabhai MRCS
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05/13/07 - 01:37 PM

U may be right.. sometimes hyperkalemia can can present with life threatning arrythmias without much EKG warning ..
I mean the most appropriate step probaby would be to put a pacemaker in 3rd degree heart blocks, but if he has described a special situation with a missed dialsis,, there may be some trick in it..
I,am not sure, maybe some one can enlighten us further.
remember he also also developed muscleweakness (3/5).

arlete
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05/13/07 - 05:44 PM

D

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