The Correct Answer is D!

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A 55-year-old man with a history of hypertension is seen in your office for evaluation of fatigue and intermittent palpitations. He has difficulty completing his daily walks, and his wife complains about his daily walks, and his wife complains of his loud snoring. On exam, he is a well-appearing man. His blood pressure is 125 over 82 mm Hg. Heart rate is 75 beats per minute, and his BMI is 25 kg/m². His cardiopulmonary exam is normal. ECG in the office demonstrates normal sinus rhythm. You decide to order a two-week non-invasive monitor to evaluate for paroxysmal atrial fibrillation.

What is the next step for this patient?

  1. Initiate an anticoagulation
  2. Titrate antihypertensive therapy
  3. Cancel the non-invasive monitor and implant a loop recorder
  4. Order a sleep study
  5. Schedule him for dual-chamber permanent pacemaker and initiate an antiarrhythmic drug