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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5642031/
https://reference.medscape.com/features/slideshow/cause-ekg-pause
Symptomatic sinus bradycardia and syncope of the vasovagal type in young healthy people may be associated with very long pauses (>30 seconds). The duration of the pause should not necessarily be a cause for concern. This is transient and the treatment is reassurance. In some circumstances, symptomatic sinus bradycardia may need to be treated if the quality of life of the patient is significantly impacted.Ep 154: 4-Step Approach to Bradycardia and BradydysrhythmiasTHE MOST COMMON CAUSE OF A PAUSE IS A NON-CONDUCTED SVES (“BLOCKED premature atrial complex PAC”). Ken Grauer https://ecg-interpretation.blogspot.com/2011/01/ecg-interpretation-review-14-pause-av.html https://ecg-interpretation.blogspot.com/2011/12/ecg-interpretation-review-33-bundle.html
https://www.aerzteblatt.de/archiv/138880/Diagnose-und-Therapie-der-Riesenzellarteriitis
More metabolic acidosis than you can shake a stick at…
VIGILANTIA et HUMILITAS 
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