Syncope, Paresthesias, and Weakness in a 35-year-old Man

November 9, 2015
Brady Pregerson, MD
Brady Pregerson, MD

Despite his symptoms the patient says he is able to function and is otherwise healthy. What clues to his condition can you spot in his ECG?

A 35-year-old man presents to the emergency department complaining of syncope. He denies any preceding chest pain, palpitations or trouble breathing, and states he did not injure himself other than a bump on his forehead. On arrival he says he has a mild headache but has not vomited and the headache is improving. He mentions that for the past few days he has had a “pins-and-needles” sensation in both hands and has experienced generalized weakness, but has been able to function. He is otherwise healthy and does not routinely see a doctor.

Physical examination is unremarkable except for a blood pressure measurement of 189/122 mm Hg and a contusion just above his eyebrow. His lungs are clear and he has no cardiac murmur. He also has a normal neurologic exam including short-term memory so a CT of the head is not ordered.

Blood is sent for routine laboratory work up and an ECG is done; the tracing is shown in the Figure.

[[{"type":"media","view_mode":"media_crop","fid":"43156","attributes":{"alt":"","class":"media-image","id":"media_crop_8025736132979","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4700","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 230px; width: 435px;","title":"Figure. ECG tracing in ED. ","typeof":"foaf:Image"}}]]

 â–º What ECG findings should you look for in a tracing for a patient who has fainted?

 â–º What does this ECG suggest?

Please leave your thoughts/comments below.

For answer and discussion, please click here.