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BMJ learning is a leader in online medical education for students and healthcare professionals worldwide test your knowledge with these sample questions from the BMJ learning module on the ECG in patients with chest pain an 82 year old man presents to his GP complaining of exertional dyspnea and chest tightness he has a background history of osteoarthritis and only takes paracetamol when required his heart rate is 38 BPM and blood pressure is 174 over 90 days clinical examination is normal what is the diagnosis a complete heart block be second degree AV block C acute coronary syndrome D sinus bradycardia you the correct answer is a complete heart block his ECG shows that there is no clear association between atrial activity p-waves and ventricular activity QRS complexes the atrial activity is also faster than the ventricular activity this indicates that he has complete or third-degree heart block this patient has narrow ventricular complexes suggesting that the interruption in conducti