Approach to bradycardia Quiz: Ace Your Exams

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A 63-year-old woman presents to a primary care clinic with a four-day history of dizziness and lightheadedness. The patient has not had fevers, chest pain, or shortness of breath. Past medical history is significant for coronary artery disease and hypertension. Medications include aspirin, ramipril, metoprolol, and atorvastatin. Temperature is 36.6°C (97.9°F), blood pressure is 110/70 mmHg, pulse is 45 beats/min, and oxygen saturation is 98% on room air. Cardiovascular examination reveals no murmurs, rubs, or gallops. An ECG tracing is obtained and is shown below. Which of the following is the most likely diagnosis?

^{Picture taken from Osmosis Block Notes}

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Mobitz type II second-degree AV block

Mobitz type I second-degree AV block

Sinus bradycardia

Third-degree AV block

Sick sinus syndrome