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Tamoxifen, an estrogen blocker, is effective in treating recent-onset and tender gynecomastia (after stopping or switching spironolactone) when administered at doses of 1020 mg twice daily

The goal here is to stabilize the patient as soon as possible, you can fiddle with the pacemaker later

The review highlights that fixed-volume dosing, higher concentrations, bilateral or continuous infusions, and patient risk factors (pregnancy, extremes of age, cardiac/hepatic disease) substantially increase risk, particularly for TAP, QLB, ESP, and PECS blocks

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314,315,329 Importantly, even small increases in daily physical activity may be beneficial