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Challenges in Clinical Electrocardiography
December 2017

The Concertina Case of Ventricular Preexcitation

Author Affiliations
  • 1Department of Medicine, University of California San Francisco, San Francisco
  • 2Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco
  • 3Department of Medicine, University of California, San Francisco
JAMA Intern Med. 2017;177(12):1842-1844. doi:10.1001/jamainternmed.2017.4857

A healthy man in his early 40s presented to the emergency department after a second syncopal episode in 2 weeks. Both episodes occurred without prodromal symptoms, tonic-clonic movements, tongue biting, or incontinence, and the patient felt normal afterward.

The patient reported having rhinorrhea and sinus congestion, as well as cough, starting shortly before his first syncopal episode. He did not have a personal or family history of heart disease, syncope, presyncope, seizures, or sudden death. Vital signs on admission were normal. Cardiac examination was notable for a normal jugular venous pressure and waveforms, a normal cardiac rhythm and rate, nondisplacement of a normal cardiac apical impulse, normal heart sounds and no murmurs, rubs, or gallops. The remainder of the physical examination was unremarkable.

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