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Discontinue all negative chronotropic agents, since the risk of torsade is much higher with bradycardia or pauses. Finally, do a coronaryangiogram Possible alternative to pacing is to give a beta-1 agonist to increase heart rate. The plan: 1. See this post: How a pause can cause cardiac arrest 2. Place temporary pacemaker 3.
He visited an outpatient clinic for it and an echocardiogram and exercise stress test was normal. His first electrocardiogram ( ECG) is given below: --Sinus bradycardia. Here is the coronaryangiogram: A distal thrombotic right coronary artery (RCA) occlusion ! He has 40 packs-year of smoking history.
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