A 57-Year-Old Man with 3 Days of Lightheadedness

The patient is a 57-year-old man who complains of lightheadedness for the last 3 days. He has a history of a heart stent placed 4 years ago and has been asymptomatic since that time. He denies vomiting, diarrhea, chest pain, shortness of breath, abdominal pain, or paresthesias. No recent travel. He takes metoprolol and clopidogrel. There is a family history of hypertension

Upon exam, you find:

• General: Sitting comfortably in a chair, alert, breathing comfortably
• Lungs: clear bilaterally
• Cardiovascular: Regular rhythm, without m,r,g
• Abdomen: Soft and NT, no distention, without r/r/g, no pulsatile mass
• Ext: No peripheral edema, pulses are 2+ and equal in all extremities, no LE pain with palpation or asymmetry

View the ECG and consider what the next steps and diagnosis would be. Resolution of the case is described on the following page.