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EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport. She was discharged with plan for outpatient cardiac MRI for further evalution. Each event is associated with a prodrome of mild substernal CP, SOB, and “brain fog.” Troponins were all negative.
Reasons for not prescibing or discontinuing were: CKD 6, severe aortic stenosis 5, asthma 3, symptomatic bradycardia 5, hypotension 3, type1 diabetes 2, syncope 1, Raynauds 1, patient choice 8 and 6 patients died before all appropriate medications could be initiated. In 10 cases no clinical reason could be identified.It
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Bradycardia 
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