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JAMA Cardiology Clinical Challenge
November 4, 2020

Syncope in a Young Woman

Author Affiliations
  • 1Division of Cardiology, Department of Medicine, University of Mississippi Medical Center, Jackson
  • 2Cardiovascular Division, Indiana University Medicine, Indianapolis
JAMA Cardiol. 2020;5(12):1446-1447. doi:10.1001/jamacardio.2020.5337

A 27-year-old woman with history of heroin use presented with syncope. She was standing and laying out a blanket for her dog before passing out. She denied prodromal symptoms and reported this was her first syncopal episode. She reported a few episodes of dizziness in the couple days prior to presentation but denied chest pain, shortness of breath, palpitations, or the recent use of illicit drugs or new medications. Shortly after arrival at the emergency department, she had a 50-second run of polymorphic ventricular tachycardia. Her vital signs and the results of her physical examination were normal. Troponin levels, thyroid levels, and the results of a complete blood cell count and metabolic panel were all normal. The results of imaging studies, including echocardiography, computed tomography (CT) pulmonary angiography, and brain CT, were also unremarkable. Coronary angiography found no evidence of obstructive coronary disease. The results of the urine toxicology test were negative. An initial electrocardiogram (ECG) at presentation was reviewed (Figure).

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