USMLE Step 3 - Question 3

A 92 year old male with hypertension and gout presents to the emergency room with an episode of passing out while sitting at the table. He has felt generally weak for the past 4 days. He denies any chest pains, shortness of breath, or other complaints. His medications include metoprolol and celecoxib. His blood pressure is 115/65, heart rate 42, respirations 12, and he is afebrile. His physical examination reveals normal lung sounds, a regular, bradycardic rhythm with varying intensities of the S1 heart sound, and intermittent large intermittent cannon A waves in the jugular venous pulsations. His laboratory studies are normal. His ECG is below. What is the appropriate treatment?

Step2-Q16-PIC2

A. Observation

B. Discontinue metoprolol

C. Permanent pacemaker implantation

D. Defibrillator implantation

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