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Old 05-18-2012
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Question Loss of Consciousness Diagnostic Dilemma

A 67 -year-old male is brought to the emergency department after a syncopal episode. He lost consciousness while shopping in the mall. He denies any nausea, diaphoresis, chest pain, or shortness of breath. He has had two episodes of lightheadedness over the last month, but has not seen a doctor. His past medical history is significant for long-standing hypertension, which is being treated with enalapril. His blood pressure is 135/90 mmHg while supine, and 130/85 mmHg while standing. His heart rate is 64/min.
ECG shows a sinus rhythm with high voltage, prolonged PR interval, prolonged QRS interval, normal QT interval and occasional premature ventricular contractions (PVC). Echocardiography reveals left ventricular hypertrophy and an ejection fraction (EF) of 55%. Which of the following is the most likely cause of this patient's syncope?

A. Bradyarrhythmia
B. Decreased myocardial contractility
C. Torsades de pointes
0. Autonomic dysfunction
E. Ventricular premature beats
F. Seizures
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Old 05-18-2012
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-seem like mobitz 2 ,A.
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Old 05-18-2012
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0. Autonomic dysfunction
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Old 05-18-2012
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just guessing.......E...
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Old 05-18-2012
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Quote:
Originally Posted by dryogi View Post
0. Autonomic dysfunction
Difference of 5 mmHg i think its normal. but pt has prolonged PR & wide QRS & adams stock attack=mobitZ 2
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Old 05-18-2012
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here's what i think
PVC don't cause syncope, autonomic dysfunction would be detected as postural HoTN i i think, so Bradiarrythmia is the most likely to fit here and esp. mobitz type II (given the ECG abnormalities)
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