A 72-Year-Old Man Is Brought to the Emergency Department After

question 390

Multiple Choice

A 72-year-old man is brought to the emergency department after an episode of syncope during a family gathering.  The patient was sitting in his chair after dinner and passed out briefly.  There are no apparent injuries and no seizure-like activity was observed.  His granddaughter says that he has had frequent episodes of dizziness in the last 2 weeks.  These episodes are sometimes accompanied by confusion and are not related to physical activity or changes in position.  The patient's other medical problems include coronary artery disease and hypertension.  He does not use alcohol or tobacco.  His medications include aspirin, lisinopril, atorvastatin, and isosorbide mononitrate.  Blood pressure is 105/60 mm Hg and respirations are 14/min.  The patient is fully alert and oriented.  Examination reveals no neck bruits.  Lung fields are clear, and no cardiac murmurs are heard.  Neurologic examination is within normal limits.  ECG is shown in the exhibit.  Serum potassium is 4.1 mEq/L and serum creatinine is 1.1 mg/dL.  Which of the following is the best next step in management of this patient?

• A)Arrangement for pacemaker
• B)Diagnostic telemetry monitoring for 24-48 hours
• C)Intravenous atropine
• D)Stress testing for chronotropic competence
• E)Stress testing for inducible ischemia

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Definitions:

Infectious Disease

Diseases caused by pathogens such as bacteria, viruses, fungi, or parasites that can spread, directly or indirectly, from one person to another.

Active Immunity

Immunity developed by the body as a result of exposure to a disease-causing organism or through vaccination, leading to the production of antibodies.

IV Fluid

A sterile liquid substance given through a vein to provide necessary nutrients or medications.

Electrolyte Imbalance

A condition where the levels of electrolytes in the body are either too high or too low, affecting bodily functions.