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Week 27

 

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Quiz 27 Context:

A 78-year-old female presents with minor injuries sustained because of a fall. The patient reports she was in her usual state of health when she suffered an abrupt witnessed loss of consciousness and fell to the ground. Their were no prodrome symptoms. She did not require CPR during this event. The patient does not recall any similar events in the past.

The patient reports a past history of hypertension, coronary artery disease, previous myocardial infarction, and peripheral vascular disease. She takes medications regularly including aspirin, a B-blocker, and a diuretic, all of which have been at stable doses. She remains physically active and does not smoke or drink alcohol.

Physical examination reveals a female patient in no acute distress. Vital signs reveal a temperature of 37.6 degrees Celsius, heart rate 65 bpm, blood pressure 130/70 mmHg. The exam is most notable for scattered abrasions consisted with minor trauma. There is a soft systolic murmur. The lungs, abdomen, and extremity exam is otherwise unremarkable.

As part of the evaluation, an EKG is done and, subsequently, a holter monitor is placed. The key findings on analysis of the holter monitor is shown above.

This history, examination, and monitor data are most consistent with which of the following possibilities as a cause for the syncope:

  1. Complete heart block
  2. Wenckebach 2nd degree block
  3. Neurocardiogenic syncope
  4. Atrial fibrillation with slow ventricular response
  5. Atrioventricular nodal re-entry tachycardia

 

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Copyright © 2000-2011 The Cleveland Clinic Foundation. All Rights Reserved.
Center for Continuing Education | 9500 Euclid Avenue, KK31, Cleveland, OH 44195