Explain complete heart block and the pacemaker to a parent — OSCE

OSCE communication and shared-planning station: explaining the diagnosis of congenital complete heart block to a parent whose newborn has a slow heart rate and a maternal history of lupus, the meaning of the blocked electrical pathway and the slow escape rhythm, the pacemaker treatment and lifelong follow-up, the implications for siblings and future pregnancies, and the restrictions on activity, with empathy and honesty.

osce communication and shared planning6 min readVerification in progress

Prompt

A first-time mother whose two-day-old daughter was found to have a heart rate of fifty-five at the routine postnatal check describes wanting to know what complete heart block means, whether her lupus caused it, whether her baby could have died, what a pacemaker involves and whether she will have it for life, and whether it will happen again in another pregnancy.

Candidate instructions

You are the paediatric registrar. You have seven minutes to speak with Mrs Tran, whose two-day-old daughter Mai was found at the routine postnatal check to have a heart rate of fifty-five beats per minute. Mai is mildly mottled and feeding slowly, and a twelve-lead ECG has shown complete heart block with a narrow-QRS escape rhythm. Mrs Tran has systemic lupus erythematosus and is known to be anti-Ro positive. She saw the registrar's worried face and overheard the word pacemaker. Explain what complete heart block is in plain language, what caused it and whether her lupus is to blame, what the pacemaker involves and whether Mai will need it for life, what the prognosis is, and what it means for any future pregnancies. Answer her questions, check her understanding, and agree a plan. [2]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References4Show ledger

[1]Shah MJ, Silka MJ, Silva JNA, et al. 2021 PACES Expert Consensus Statement on the Indications and Management of Cardiovascular Implantable Electronic Devices in Pediatric Patients. JACC Clin Electrophysiol, 2021.PMID 34794667
[2]Baruteau AE, Pass RH, Thambo JB, et al. Congenital and childhood atrioventricular blocks: pathophysiology and contemporary management. Eur J Pediatr, 2016.PMID 27351174
[3]Michaëlsson M, Jonzon A, Riesenfeld T Isolated congenital complete atrioventricular block in adult life. A prospective study. Circulation, 1995.PMID 7634461
[4]Eronen M, Sirèn MK, Ekblad H, et al. Short- and long-term outcome of children with congenital complete heart block diagnosed in utero or as a newborn. Pediatrics, 2000.PMID 10878154