Test Your Knowledge of Urgent Care Approach to the Syncopal Patient (Postscript 4 of 4)

EBUC Postscripts
Urgent Care Approach to the Syncopal Patient | December 2021

A 37-year-old woman presents to urgent care with complaints of dizziness and palpitations. She was in her usual state of health when symptoms started abruptly about 30 minutes prior to her arrival at urgent care. The symptoms began with only light exertion while she was shopping. On questioning, she states that her dizziness is much more of a “light-headed” feeling than a sensation of spinning or abnormal motion. There is mild associated shortness of breath, but no chest pain or headache. She is on no medications, but drinks caffeinated drinks in moderate amounts; however, she says she did not have any more caffeine today than on a typical day.

On examination, the patient is conversant and pleasant, but somewhat anxious appearing. Her vital signs on the automated blood pressure (BP) cuff are: blood pressure, 88/60 mm Hg; heart rate, 112 beats/min; respiratory rate, 24 breaths/min; temperature, 97.9°F; and oxygen saturation, 96% on room air. Upon auscultation of the chest, her heart rate seems much faster than the 112 beats/min registered by the automated BP cuff, but heart sounds are regular with no obvious murmur or extra sounds. The following ECG is obtained:

Source: Life in the Fastlane
Used with permission of Life in the Fastlane

What is your interpretation of the ECG, and what is the best explanation for this patient’s hypotension and near syncope?

A. Atrial fibrillation with rapid ventricular response and diffuse ST abnormality; decreased myocardial contractility

B. AV nodal reentry tachycardia; rate-related decrease in cardiac output due to inadequate left ventricle filling

C. Sinus tachycardia with diffuse ST depression; decreased myocardial contractility due to ischemia

D. Atrial flutter with 2:1 ventricular conduction; rate-related decreased cardiac output due to inadequate left ventricle filling

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Last Updated on January 26, 2023

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