Cardiology Case Report: Chest Pain and Syncope

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This case report from Brady Pregerson, MD, features a woman in her late 60s with diabetes mellitus and hypertension presenting to the emergency department with 3 hours of chest heaviness, nausea, and lightheadedness. Can you determine the diagnosis?


A patient in their late-60’s with DM and HTN but no known heart disease presents to the hospital with 3 hours of chest heaviness, nausea and lightheadedness and actually fainted once without injury. Medics state her heart rate was in the mid-20s and they gave atropine 2 mg without improvement. They also gave Zofran. The patient mentioned she did have a recent upper respiratory infection. She is not on a beta blocker or calcium blocker.


Vital signs are remarkable for a HR in the mid 20’s and BP in the low 80’s with no palpable radial or pedal pulse. The physical exam is otherwise normal.

An ECG is done:

What is the most likely rhythm in this patient?