Image of the Week: How Would You Manage This Patient’s Arrhythmia? - Clinical Advisor

Image of the Week: How Would You Manage This Patient’s Arrhythmia?

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A 60-year-old woman with a history of non-small cell lung cancer presents to the emergency department reporting shoulder and neck pain for the last 6 hours. The lung cancer was excised 3 years earlier with an excellent prognosis. An initial electrocardiogram demonstrates sinus tachycardia resembling atrial flutter. The patient receives 20 mg of intravenous diltiazem and begins having sinus pauses that last 2 to 4 seconds and occur multiple times each minute. Her blood pressure is 115/70 mm Hg, and her heart rate between pauses is 90 to 120 beats per minute with intermittent P waves. Her chest radiograph demonstrates expected postoperative changes. The patient is alert and oriented and experiences intense anxiety with each pause.

Which of the following next steps in management is most appropriate?

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