5th May 2025

Mrs Chatterjee is a 79-year-old lady with a past medical history of ischaemic heart disease, congestive cardiac failure (ejection fraction 45%), hypertension, type 2 diabetes mellitus and hypercholesterolemia.

Mrs Chatterjee is a 79-year-old lady with a past medical history of ischaemic heart disease, congestive cardiac failure (ejection fraction 45%), hypertension, type 2 diabetes mellitus and hypercholesterolemia. At her routine follow-up in cardiology clinic, you note she is mildly short of breath walking from the waiting area into the consultation room. On asking, she denies any chest pain, syncope or palpitations. On examination, you notice faint bi-basal coarse crackles at the lung bases with minimal pitting oedema to the knees bilaterally. The remainder of the physical examination is unremarkable. Her GP recently started her on some medications for her symptoms. You notice the following 12-lead ECG below. Which of her medications is most likely to cause the findings on the ECG trace below?

Select the SINGLE most appropriate option from the list below. Select ONE option only.