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Electrocardiogram (ECG) and telemetry revealed junctional bradycardia with heart rate in 30s and sinus pauses (5-7 seconds). He was admitted for further workup of bradycardia. His home medications included metoprolol succinate 25mg daily which was held given bradycardia. Initial laboratory analysis was unremarkable.
He also had a history of chronic kidneydisease, stage III. Angio had shown some acute disease in the saphenous vein graft to the posterior descending artery off of the RCA. There is also bradycardia. Bradycardia puts patients at risk for "pause-dependent" Torsades de Pointes. Most recent echo showed EF of 60%.
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