Our latest emergency department minute quiz from Brady Pregerson, MD. Can you determine the correct diagnosis?
History: A man in his 60’s with a history of a-fib presents to the urgent care for dizziness and malaise. He noticed on his apple watch that his pulse was slow. He denies syncope, palpitations, chest pain, SOB, fever, cough or other complaints.
Exam: Vital signs are normal except for a pulse of 42. His exam is otherwise normal.
An EKG is done
COMPUTER EKG READ:
Atrial fibrillation with slow ventricular response
Moderate intraventricular conduction delay
ST deviation and moderate T-wave abnormality, consider lateral ischemia
What is the most likely diagnosis?
Sick Sinus Syndrome
Acute Coronary Syndrome
1-Minute Consult (from the Emergency Medicine 1-Minute Consult Pocketbook) on the topic for this case: