100 Cases in Clinical Medicine

(Rick Simeone) #1

The treatment should be insertion of a pacemaker. If the rhythm in complete heart block
is stable then a permanent pacemaker should be inserted as soon as this can be arranged.
This should be a dual-chamber system pacing the atria then the ventricles (DDD, dual
sensing and pacing, triggered by atrial sensing, inhibited by ventricular sensing) or pos-
sibly a ventricular pacing system (VVI, pacing the ventricle, inhibited by ventricular sens-
ing). If there is doubt about the ventricular escape rhythm then a temporary pacemaker
should be inserted immediately.

  • When a patient suffers transient loss of consciousness, a careful history from a witness
    may help with the diagnosis.

  • Normal examination and ECG do not rule out intermittent serious arrhythmias.

  • Large waves in the jugular venous pressure are usually regular giant v-waves in tricuspid
    regurgitation or intermittent cannon a-waves in complete heart block.


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