What should be done if a patient has 2nd or 3rd degree heart block?

• A. Administer atropine
• B. Begin amiodarone
• C. Go directly to transcutaneous pacing, as they likely will not respond to atropine.
• D. Observe

Answer: (C)

High-grade AV block means the electrical signal cannot reliably move from the atria to the ventricles, and the problem is often below the AV node. Atropine increases conduction mainly through the AV node, so it is unlikely to restore a safe heart rate in Mobitz II or complete heart block. The priority is to provide reliable pacing to maintain heart rate and perfusion, which is why transcutaneous pacing is the best immediate intervention. Amiodarone would not help and can worsen bradycardia, while simply observing is unsafe in a symptomatic, potentially unstable block. Transcutaneous pacing buys time and stabilizes the patient while arranging definitive pacing support.