Question of the Week # 386

386)  A 54 year old man presents to the emergency room with dizziness and intermittent palpitations for the past 12 hours. He denies any syncopal episodes or headache or seizures. He has no significant cardiac history. He was seen in the outpatient clinic one week ago for pneumonia and was started on Moxifloxacin. His other medical problems include hypertension for which he is on enalapril and Gastro-esophageal reflux disease for which he takes esomoprazole.  Physical examination reveals regular heart sounds and no murmurs.  Complete Blood Count and Serum electrolytes are within normal limits. An electrocardiogram is obtained and is shown below:



Which of the following is the most appropriate action at this time?

A) Intravenous Magnesium sulfate

B) Discontinue Moxifloxacin

C) Discontinue Esomoprazole

D) Transvenous Pacing

E) Intravenous Isoproterenol