Atrioventricular block Quiz: Ace Your Exams

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A 21-year-old man presents to the clinic for a physical exam and ECG prior to running a marathon. He has not had lightheadedness, chest pain, shortness of breath, fatigue, or syncope. His past medical history is unremarkable and he is not taking any medications. Family history reveals that his father has hypertension. He has no known drug allergies and does not smoke or use other recreational drugs. His diet is well-balanced, and he trains rigorously. Temperature is 37°C (98.6°F), blood pressure is 130/80 mm Hg, heart rate is 50/min, respiratory rate is 12/min, and oxygen saturation is 98% on room air. Physical examination reveals a well-developed, thin, athletic man with a normal cardiovascular exam. There is no jugular venous distension, peripheral edema, or calf tenderness. An ECG is performed and is shown below. Which of the following is the most likely diagnosis?  


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