New Year’s Resolution: a patient who is trying to get healthier presents to the ED with this unstable bradycardia

ECG Weekly Workout with Dr. Amal Mattu

HPI

A 50-year-old man decides to get “his life in order” for the new year. He quits smoking, decides to eat healthier, exercise more, and to be more compliant with his blood pressure medications. A week into the new year he wakes up feeling weak and achy with nausea and vomiting. He is lightheaded when sitting or standing and has trouble getting out of bed. He is found to be hypotensive and bradycardic by EMS. The following ECG is obtained on arrival to the emergency department:

Before watching the video, look closely at this ECG and ask yourself:

    1. How would you manage this patient if atropine and transcutaneous pacing don’t work?
    2. What is the most likely diagnosis?