The teaching point here is that you have everything you need to know already. The EKG shows complete heart block (CHB).
The patient walked in. That means he is stable. The emergent ddx of complete heart block include MI, meds / overdoses, hyperkalemia. The less emergent ddx include carditis (Lyme, e.g.), cardiomyopathy, and many others. If the patient is in CHB from MI, overdose, or hyperkalemia, he is not walking in. Thus, the patient does not require emergent treatment. He only needs to be admitted.
When we spoke to the patient, he said that he had two episodes of syncope in the previous week, so it’s likely that he has been in heart block for a week already. He also told us that his sister had a ppm placed in her 40s, thus this is very likely to be congenital.
The patient was admitted to the CCU for monitoring. He remained in CHB. A ppm was placed. He was discharged after a few days.