A 72-year-old man is referred to the Emergency Department by his GP after an abnormal ECG during a routine review. He has no current symptoms of chest pain, palpitations, syncope, or presyncope.
Observations on arrival:
- Heart rate: 74 bpm, regular
- Respiratory rate: 16/min
- Blood pressure: 138/84 mmHg
- Temperature: 36.8°C
- Oxygen saturation: 98% on room air
- GCS: 15
Examination findings:
- Cardiovascular and respiratory examinations are unremarkable.
- No peripheral oedema, no murmurs.
Past Medical History:
- Hypertension
- Type 2 diabetes mellitus
Medications:
- Amlodipine
- Metformin
Investigations:
- ECG: Sinus rhythm with right bundle branch block and left anterior fascicular block
- Bloods: U&E's, calcium, and magnesium all within normal limits. Troponin negative.
What is the most appropriate management for this patient in the Emergency Department?
A
Admit for cardiac monitoring and urgent permanent pacemaker insertion
B
Admit for cardiac monitoring and temporary pacing wire insertion
C
Discharge with a safety-net
D
Discharge with routine outpatient cardiology referral and no further advice
E
Admit for cardiac monitoring and electrophysiological study