Emergency Department Minute Quiz: Woman w/ Constipation and Weakness

A woman in her 60’s with a history of breast cancer who has been seeking alternative treatments in Mexico presents to the emergency department with generalized weakness, constipation, and generalized abdominal cramping. The symptoms have all been getting progressively worse over the past 1-2 weeks. She denies any focal weakness, headache, fever or other complaints.

Vital signs are remarkable for a pulse of 50 and BP of 92/70. The temperature and pulse ox are normal. On exam lungs are clear and the heart is slow and soft. Her abdomen is benign and she has no CVA tenderness or leg edema.

See her EKG below: