Scenario: This ECG (V1 top and lead II bottom) was obtained from a 78-year-old female patient admitted to the cardiac intensive care unit 3 weeks earlier. She was admitted with respiratory distress and is currently intubated via a tracheal tube, on phenylephrine hydrochloride for blood pressure control, is in septic shock, and requiring dialysis every other day. She has an extensive clinical history including: hypertension (HTN), coronary artery disease (CAD), prior myocardial infarction (MI), heart failure (HF), chronic obstructive pulmonary disease, type II diabetes, hypothyroidism, and chronic kidney disease. The patient is nonresponsive so subjective symptoms could not be ascertained. Her blood pressure dropped from 108/60 to 85/43 during this rhythm.

Sick sinus syndrome (SSS) is characterized by: (1) impairment of impulse formation in the sinoatrial node, (2) failure of the lower pacemaker cells (AV junction, bundle branches, and Purkinje) to generate...

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