Red flags
- Adverse signs: shock, syncope, ischaemic pain, HF
- Mobitz II or complete heart block
- Recent MI (inferior for CHB)
First steps
- ABCDE + defib pads (external pacing standby)
- IV access + 12-lead ECG
- Identify drug cause
Key investigations
- 12-lead ECG (block type)
- K+, TFT, digoxin level
- Troponin, echo
Differentials
- Sinus brady physiological
- Sick sinus syndrome
- Drug-induced (β-blocker, CCB, digoxin, amiodarone)
- Hypothyroidism, hypothermia
Initial management
- Atropine 500 mcg IV q3-5 min (max 3 mg)
- Refractory: transcutaneous pacing
- Isoprenaline 5 mcg/min or adrenaline 2-10 mcg/min
- Transvenous pacing definitive
- Treat cause
Referral
- Cardiology for permanent pacemaker assessment
AI clinical assessment
Enter patient details to generate evidence-based guidance.
This tool is for educational and clinical support only. It does not replace professional medical judgment or institutional protocols.
