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Emergency Department Minute Quiz: Malaise and Bradycardia

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


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?

Beta-blocker toxicity

Digoxin toxicity

Sick Sinus Syndrome

Acute Coronary Syndrome

1-Minute Consult (from the Emergency Medicine 1-Minute Consult Pocketbookon the topic for this case: