LAUSR

A 62yearold man presented to hospital complaining of 3 days of abdominal discomfort on a background of a monthlong history of fatigue and fevers. He was a past smoker of 12 years and did not use illicit drugs. His medical history was otherwise unremarkable. His abdominal discomfort was epigastric, constant, nonradiating and unaffected by food. There was no associated change in bowel habit. In the emergency department, he was afebrile (37.2°C) but looked unwell. His heart rate was 30 beats per minute, blood pressure was 105/65 mmHg, heart sounds were normal without audible murmurs, and peripheral examination was unremarkable. Jugular venous pressure was normal. He was tender in the epigastrium without guarding or rebound tenderness. Murphy sign was negative. The liver edge was palpable but not tender or pulsatile. Electrocardiography showed complete heart block (Box 1).