Complete Heart Block in an 80-Year-Old on Digoxin and Bisoprolol
A branching clinical case simulation for a patient presenting with recurrent syncope. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.
Year 5medium20 min6 stages
- Patient
- 80 years, female
- Presenting complaint
- Recurrent syncope
- Decision stages
- History, Examination, Investigations, Diagnosis, Treatment, Monitoring
The presentation
You are the Year 5 medical student on an acute medical unit at a district general hospital. A nurse calls you to see an 80-year-old woman, Elsie Hartley, who has had a syncopal episode at home. She is on the trolley, alert but complaining of dizziness. Her observations show a pulse of 34 beats per minute and a blood pressure of 90/50 mmHg. She has a two-week history of recurrent syncope. She takes regular medications, but the list is not immediately available.
What this case teaches
Recognise complete heart block on the ECG; identify drug causes; give atropine and arrange pacing; stop the offending medicines.
How the case unfolds
- 1Initial assessment and historyHistory
- 2Focused examinationExamination
- 3InvestigationsInvestigations
- 4Diagnostic reasoningDiagnosis
- 5Immediate managementTreatment
- 6Monitoring and next stepsMonitoring
The decisions available at each stage, and what each one costs or earns, appear when you run the case.
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A free account opens the simulator: the patient's observations move with your decisions, and every choice is scored and explained.
Taught in
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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.