MRCP2-0366

MRCP2-0366

An 87-year-old male presents to the diabetic ulcer clinic for regular foot care when regular observations note his heart rate to be 42 beats per minute. His blood pressure is 140/60 mmHg and he reports no recent episodes of syncope. A 12 lead ECG demonstrates Mobitz type 1 rhythm at 42 beats/ minute. A 24 hours tape performed as an outpatient demonstrates bradycardia with up to 2.7 second pauses. His past medical history includes type 2 diabetes mellitus, hypertension and angina. His medications include ramipril, furosemide, verapamil, metformin and GTN on an as-required basis. During this second encounter, his heart rate is 41 beats/min and his blood pressure is 120/ 58 mmHg. He informs you that he is guided by you in terms of the most appropriate treatment. What do you advise?