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Challenges in Clinical Electrocardiography
April 10, 2017

Recurrent Syncope in the Emergency DepartmentA Lethal Cause Not for the Faint Hearted

Author Affiliations
  • 1Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
JAMA Intern Med. Published online April 10, 2017. doi:10.1001/jamainternmed.2017.0580

A woman in her 50s with a history of hypertension and alcohol abuse presented to the emergency department with 4 episodes of syncope in the preceding 24 hours. She denied prodromal symptoms of chest pain, dyspnea, palpitations or presyncope. Her medications included perindopril, metoprolol, and a magnesium supplement. On examination, her blood pressure was 121/79 mm Hg, heart rate was 65 bpm, and her respiratory rate was 24 breaths/min. She was afebrile and had normal oxygen saturations on room air. A 12-lead electrocardiogram (ECG) was obtained (Figure 1).

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