A 70-year old hypeensive patient with a complaint of palpitations and pre-syncope. On examination, his hea rate is 72 BPM and BP was 150/100. ECG performed shows?
**Core Concept**
The patient's symptoms of palpitations and pre-syncope, along with a history of hypertension, suggest a possible arrhythmia. The ECG is a crucial diagnostic tool to identify the underlying cardiac rhythm disorder.
**Why the Correct Answer is Right**
The patient's symptoms and ECG findings are suggestive of sinus bradycardia. Sinus bradycardia is a cardiac rhythm disorder characterized by a heart rate less than 60 beats per minute (BPM) in adults. In this case, the patient's heart rate is 72 BPM, which is slightly below the normal range. The underlying mechanism is a decrease in the firing rate of the sinoatrial (SA) node, the natural pacemaker of the heart. This can be due to various factors, including age-related changes, medications, or underlying medical conditions such as hypertension.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is likely a distractor representing a normal heart rate, which does not explain the patient's symptoms of palpitations and pre-syncope.
**Option B:** This option might represent a tachyarrhythmia, such as atrial fibrillation, which would typically present with a rapid and irregular heart rate, not a bradycardia.
**Option C:** This option is likely a distractor representing a normal heart rate, which does not explain the patient's symptoms of palpitations and pre-syncope.
**Option D:** This option might represent a junctional rhythm, which would not be consistent with the patient's symptoms of palpitations and pre-syncope.
**Clinical Pearl / High-Yield Fact**
It's essential to note that a heart rate of 60 BPM or less in adults should be further evaluated with a 12-lead ECG and possibly a Holter monitor to rule out underlying cardiac rhythm disorders.
**Correct Answer:** A. Sinus bradycardia.