Case No. 13

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Case No. 13


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Chief Complaint:

Syncope and palpitations

Published: April 24, 2017
Author: Medzcool

A 33year old with no past medical history presents to your Emergency Department for syncope. The patient states he was walking to work this morning when he developed sudden onset dizziness and palpitations. He sat down and fainted shortly afterwards. He denies head trauma. He believes he was unconscious for approximately 30 seconds and has been mentating normally since the incident. No recurrent episodes of syncope. He denies chest pain, shortness of breath, recent illnesses and infectious symptoms. The patient is currently not on any medications. In terms of family history, the patient states his father died of a “heart condition” in his 40s. On Exam his vitals are temp 37.4, HR 77, BP 136/77, RR 18, O2 Saturation of 100% on RA. His fingerstick glucose is 105. He has no evidence of head trauma. His cardiac exam is regular rate and rhythm with no murmurs, rubs or gallops. His lungs are clear to auscultation throughout. He has a benign abdominal and neurologic exam. His EKG is seen in case images.


What is the underlying problem associated with this patients condition?

  • Electrical conduction through an accessory pathway
  • Mutation in the SCN5A gene associated with sodium channels
  • Electrolyte imbalance leading to a prolonged QT interval
  • Thickened interventricular septal tissue leading to a decrease in cardiac output

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