A 72-Year-Old Man Comes to the Office Due to Palpitations

A 72-year-old man comes to the office due to palpitations for the past 1 week.  The patient has had no fever, cough, chest pain, or dizziness.  Medical history is significant for mild chronic obstructive pulmonary disease, long-standing hypertension, hyperlipidemia, and chronic stable angina.  He uses an albuterol/ipratropium inhaler as needed.  The patient is a former smoker; he does not use alcohol but drinks 2 or 3 cups of coffee daily.  Temperature is 37.1 C (98.8 F) , blood pressure is 136/78 mm Hg, pulse is 116/min, respirations are 16/min.  Oxygen saturation is 97% on room air.  On physical examination, the patient appears comfortable with normal work of breathing.  Lung auscultation reveals mildly prolonged expiration with no wheezing or crackles.  Cardiac examination shows irregular tachycardia.  The remainder of the physical examination is unremarkable.  ECG rhythm strip is shown in the exhibit.  Which of the following most likely increased the risk of development of this patient's arrhythmia?

A) Acquired long QT syndrome
B) Beta-2 agonist use
C) Caffeine consumption
D) Chronic hypertension
E) Coronary artery disease

Correct Answer:

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