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A man in his 70s with chronic obstructive pulmonary disease, hypertension, coronary artery disease, ischemic cardiomyopathy, and sick sinus syndrome with permanent pacemaker became lightheaded after quickly standing from bed, fell, and twisted his right ankle. He denied loss of consciousness, weakness before or after the fall, chest pain, palpitations, or new or worsening symptoms of heart failure. Neurological examination findings were normal. X-ray examination of the right ankle revealed a fracture.
Burns SJ, Orner JD, Lacy ME. Avoidance of Carotid Ultrasound in Syncope—Keeping It SimpleA Teachable Moment. JAMA Intern Med. 2016;176(7):892-893. doi:10.1001/jamainternmed.2016.2531