A 79-year-old male with past medical history of hypertension and coronary artery disease presents to urgent care with left shoulder pain that is worse with movement. He reports intermittent nausea and vomiting, but denies dizziness, chest pain, shortness of breath, or history of trauma.

View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Second-degree atrioventricular block, 2:1 conduction
Figure 1. Initial ECG.
(Case presented by Catherine Reynolds, MD, McGovern Medical School at UTHealth Houston Department of Emergency Medicine.)
A 79-Year-Old Male with Left Shoulder Pain and a History of Hypertension and CAD
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