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).
Chew DS, Rezazadeh S, Miller RJ. Recurrent Syncope in the Emergency DepartmentA Lethal Cause Not for the Faint Hearted. JAMA Intern Med. Published online April 10, 2017. doi:10.1001/jamainternmed.2017.0580