امرأة عمرها ٧٤ سنة على التنظيم عبر الجلد لإحصار قلبي كامل، والتنظيم فعال وضغطها تحسن إلى ١٠٤/٦٢. لكنها واعية وتبكي وتشتكي ألماً شديداً وانقباضاً في صدرها مع كل نبضة. ما التصرف الصحيح؟

A 74-year-old woman is on effective transcutaneous pacing for complete heart block, with BP improved to 104/62. She is awake, crying and complaining of severe pain and chest muscle contraction with each paced beat. What is the correct action?

1. Lower the current until capture is lost
2. Move the pads every minute to reduce the pain
3. Give analgesia and sedation as ordered; keep pacing
4. Stop pacing because pain means it is not working

Answer: C) Give analgesia and sedation as ordered; keep pacing. Transcutaneous pacing is painful because it stimulates the chest muscles. Analgesia and sedation are given as ordered while pacing continues as a bridge to transvenous or permanent pacing.