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BACKGROUND
An 18-year-old woman presents to the emergency department (ED) after experiencing syncope while backpacking 2 days ago. The patient states that she had been hiking with her friends up a steep hill, and the next thing that she remembered was waking up, lying on the trail. The event was not witnessed, and the patient does not recall any antecedent chest pain, shortness of breath, palpitations, or dizziness. She denies biting her tongue or having incontinence at the time of the event, but she remembers briefly feeling dazed. After a period of rest, she was able to finish the hike without further problems, but she comes into the office to get checked out just to be safe. She denies any past medical problems but does report experiencing a similar syncopal episode a few years ago again while she had been exerting herself. She has no recent history of illness or fever and does not report any subsequent chest pains, shortness of breath, or palpitations. She also denies recent dieting or use of any over-the-counter or illicit drugs.
On examination, the patient has a normal temperature with a heart rate of 65 bpm and a blood pressure of 110/73 mm Hg. She is a well-appearing young woman in no acute distress. Findings on her head and neck examination are unremarkable. She has normal S1 and S2 heart sounds without any appreciated rubs, murmurs, or gallops. She has no jugular venous distention, and her lungs are clear bilaterally. Her abdomen is soft, without masses. She has no peripheral edema, and findings on neurologic examination are normal. Results of her laboratory work-up, including a complete blood count, chemistry panel, pregnancy test, and toxicology screen are normal. Her chest radiograph was likewise normal.
An ECG is obtained (see Image). What is the diagnosis?
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Hint
The patient recalls that her younger brother has had similar episodes of syncope over the past few years.
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Authors:
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Malkeet Gupta, MS, MD,
Department of Emergency Medicine, UCLA/Olive View-UCLA Emergency
Medicine Residency Program, Los Angeles, Calif
Rick Kulkarni, MD, Attending Physician, Director of Informatics,
Department of Emergency Medicine, Olive View - UCLA Medical Center,
Assistant Professor of Medicine, David Geffen School of Medicine at UCLA |
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eMedicine Editor:
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John Vozenilek, MD, Division
of Emergency Medicine, Evanston Northwestern Healthcare |
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