A 55 year old female patient comes to your OPD with complaints of dizziness on standing up since 6 months.

 A 55 year old female patient comes to your OPD with complaints of dizziness on standing up since 6 months. On history taking, you find out the patient was diagnosed as having hypertension 1 year ago and has been started on Atenolol 100 mg once a day by a GP. You check her Blood pressure which is 130/80 mmHg.

You decide to conduct an ECG which is shown below:

A. What are the findings in the ECG which can explain the dizziness and the reason of this finding?

B. What should be the next step in management of this patient?

A. The ECG shows regular rhythm but there is Bradycardia. ( Heart rate of less than 60 BPM) which is most likely due to a high dose of Atenolol.

B. It might be a useful step to reduce dose of Atenolol to 50 mg once a day, and then monitor her Blood pressure and heart rate. If symptoms settle, then the lower dose can be continued. Otherwise it should be replaced with another antihypertensive like Amlodipine which has lesser depressive effect on heart rate.