A 55-year-old patient with a history of hypertension is undergoing a routine ECG as part of their annual check-up. The ECG reveals a first-degree AV block. Which of the following statements about first-degree AV block is correct?

First-degree AV block is characterized by a prolonged PR interval greater than 0.20 seconds.

First-degree AV block is a type of heart block where some atrial impulses fail to reach the ventricles.

Patients with first-degree AV block typically present with symptoms such as syncope or dizziness.

First-degree AV block often requires immediate treatment with a pacemaker.

Answer and Explanation

The Correct Answer is A

Rationale:

A. In first-degree atrioventricular (AV) block, all atrial impulses reach the ventricles, but conduction through the AV node is delayed. This delay is reflected on the ECG as a PR interval longer than 0.20 seconds, while the QRS complex remains normal. First-degree AV block is usually asymptomatic and often does not require treatment.

B. This description fits second-degree AV block, not first-degree. In first-degree block, no impulses are blocked, only delayed.

C. First-degree AV block is generally asymptomatic, and patients rarely experience symptoms. Symptoms such as syncope are more characteristic of higher-degree AV blocks.

D. Pacemaker therapy is not indicated for first-degree AV block unless it progresses to higher-degree AV block with symptomatic bradycardia. Immediate intervention is not needed in asymptomatic patients.

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Correct Answer is D

Explanation

Rationale:

A. Atropine is a parasympatholytic medication used to increase heart rate in cases of bradycardia by inhibiting vagal stimulation. It has no effect on coagulation pathways and therefore does not reverse the anticoagulant effects of warfarin.

B. Epinephrine is a sympathomimetic used primarily in cardiac arrest, anaphylaxis, or severe hypotension. While it affects heart rate and vascular tone, it does not interact with the coagulation cascade or reduce an elevated INR.

C. Protamine sulfate is the specific antidote for heparin therapy. It binds to heparin to neutralize its anticoagulant effect but is ineffective against vitamin K antagonists such as warfarin. Administering protamine would not correct the patient’s supratherapeutic INR.

D. Vitamin K (phytonadione) is the antidote for warfarin. Warfarin inhibits the vitamin K–dependent synthesis of clotting factors II, VII, IX, and X. An elevated INR of 5.2 indicates that the client is at high risk for spontaneous bleeding. Administering vitamin K helps restore the synthesis of functional clotting factors, thereby reducing bleeding risk. The dose and route (oral vs. IV) depend on the severity of the INR elevation and presence of active bleeding.

A. Septal myectomy B. Pericardial window for continuous drainage C. Synchronized electrical cardioversion D. Pericardiocentesis

Correct Answer is C

Explanation

Rationale:
A. This is a surgical procedure for hypertrophic obstructive cardiomyopathy, not atrial fibrillation. It is unrelated to managing AF or symptomatic palpitations.

B. This procedure is used for continuous drainage of pericardial effusions or cardiac tamponade, not for treating atrial fibrillation.

C. This is the treatment of choice for symptomatic atrial fibrillation with rapid ventricular response when medication is insufficient or immediate rhythm control is needed. The procedure delivers a controlled electrical shock synchronized with the QRS complex to restore normal sinus rhythm safely.

D. This is used to remove excess fluid from the pericardial sac in cases of pericardial effusion or tamponade, not for atrial fibrillation management.

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A 55-year-old patient with a history of hypertension is undergoing a routine ECG as part of their annual check-up. The ECG reveals a first-degree AV block. Which of the following statements about first-degree AV block is correct?

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Correct Answer is D

Explanation

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Correct Answer is C

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