ECG Challenge: Lightheadedness and Slow, Irregular Pulse

Philip J. Podrid, MD


June 17, 2021

A 52-year-old man with a history of coronary artery disease and hypertension — treated with an angiotensin-converting enzyme (ACE) inhibitor, a beta-blocker, and long-acting nitrate — visits the emergency department with complaints of lightheadedness for 1 week and a presyncopal episode shortly before presentation. Blood pressure is normal, but pulse is slow and slightly irregular. A 12-lead ECG is obtained.

Figure 1. Courtesy of Dr Podrid.


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