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Syncope & Bradycardia

UnFiNiShEd CaSe CoMe BaCk LaTeR

“BRADY” DOWN FOR THE REST

History:

A 22-year-old male with no PMH is brought to the ED for syncope.  He was getting a haircut when he fainted.  Medics say on arrival his BP was in the 60’s and the HR was in the low 30’s.  The patient states that he has fainted a bunch of times in the past but never saw a doctor for it.  He denies palpitations, chest pain, SOB, fever, cough or other complaints.

Exam:

Vital signs are normal except for a pulse of 48.   Exam is otherwise normal.

Initial differential diagnosis:

  • Bradydysrhythmia
  • Vasovagal episode
  • Panic attack
  • Hypothyroidism
  • ACS

Initial EKG (click TWICE if you want to enlarge):

COMPUTER EKG READ:

  1. Sinus Bradycardia
  2. Borderline ECG

Do you agree with the computer?

“BRADY” DOWN FOR THE EKG ANALYSIS & 1-MINUTE CONSULT

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EKG ANALYSIS, CASE CONCLUSION & 1-MINUTE CONSULT: Peer Reviewed by Dr. Stephen W. Smith of Dr. Smith’s ECG Blog

  • EKG Analysis: The computer read is correct
  • Case Conclusion: labs and orthostatics were normal.  The patient stated he wouldn’t have come to the ED if this had happened at home.  On further probing questions you determine that the syncope occurred while the barber was shaving his neck.  Carotid sinus hypersensitivity is diagnosed.
  • 1-minute Consult: See highlighted area of sample page below and Case Lessons below that.

1-Minute Consult on the EKG topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

Source: The Emergency Medicine 1-Minute Consult Pocketbook   

Case Lessons

  1.   

Peer Review: Dr. Stephen W. Smith of Dr. Smith’s ECG Blog

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