A 57-Year-Old Man with a Chief Complaint of Syncope 3 Hours Ago

Case

The patients is a 57-year-old man with a complaint of syncope 3 hours before arrival. He states he was sitting on the couch and the next thing he knew he was waking up. No preceding dizziness. No seizure activity, biting of the tongue, blood in the mouth, or post ictal symptoms. No cp, sob, leg pain, head pain, or back pain. He drank 2 glasses of water and felt better, but was encouraged to seek urgent care by his family.

Upon exam, you find:

• General: Sitting on the cart, pink, skin dry, breathing comfortably and speaking normally
• 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 edema or asymmetry, pulses are 2+ and equal in all extremities, no LE pain

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