Approach to bradycardia Quiz: Ace Your Exams
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A 64-year-old man presents to the primary care clinic with complaints of fatigue, lightheadedness, and recurrent episodes of palpitations. The patient has not had chest pain, shortness of breath, or syncope. He does not recall any specific situations that bring on the symptoms. There is no recent history of tick bites, rash, or fever. Past medical history is significant for hypertension controlled with hydrochlorothiazide. The patient is physically active and walks three times per week. The patient does not smoke. Temperature is 37.1°C (97.9°F), blood pressure is 128/84 mmHg, pulse is 47/min, respiratory rate is 18/min, and oxygen saturation is 98% on room air. Physical examination is unremarkable. A 12-lead ECG reveals sinus bradycardia. Initial laboratory evaluation, including CBC, electrolytes, and TSH, are unremarkable. Which of the following is the most appropriate next step in diagnosis?
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