An Alarming Change in Heart Rate in a Renal Patient: Analyze This: Image of the Week

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A 63-year-old man presents to the emergency department (ED) for an evaluation of new-onset renal failure. The patient's primary care physician has referred him to the ED after routine laboratory tests demonstrated a blood urea nitrogen (BUN) level of 83 mg/dL (30 mmol/L) and a creatinine level of 4.4 mg/dL (389 µmol/L).


The patient reports feeling well, without any current symptoms. He denies having any chest discomfort, difficulty breathing, or palpitations. He has a history of urinary hesitancy secondary to benign prostatic hypertrophy, but he is voiding as usual. His medical history is also significant for diabetes mellitus, hypertension, and a remote history of syncope."