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Quiz

Neurology

A Young Man With Syncope

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Cardiology

Published Online: June 8, 2022

JAMA Cardiology Clinical Challenge

Article Information and Disclosures

Asad J. Torabi, MD¹;

Mark Kauth, MD¹;

Takeki Suzuki, MD, PhD²

Author Affiliations

¹Division of Cardiology, Krannert Institute of Cardiology at Indiana University School of Medicine, Indianapolis
²Clinical Medicine, Department of Medicine/Cardiology, Indiana University School of Medicine, Indianapolis

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A man in his early 20s presented with suspected syncope and shaking with no significant medical history. The patient fell asleep and his girlfriend tried to wake him, but he started shaking and slumped over on the ground. He denied confusion afterward but did not feel well with nausea, flushing, chest tightness, and a rapid heart rate. About 10 minutes later, he had a second syncopal episode for 2 to 3 minutes with more than 20 muscle jerks. On presentation at the emergency department, he was afebrile, blood pressure was 120/59 mm Hg, heart rate was 85 beats per min, respiratory rate was 16 breaths per min, and oxygen saturation was 96% on room air. His cardiac examination revealed normal heart sounds with no murmurs.

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A man in his early 20s presented with suspected syncope and shaking with no significant medical history. The patient fell asleep and his girlfriend tried to wake him, but he started shaking and slumped over on the ground. He denied confusion afterward but did not feel well with nausea, flushing, chest tightness, and a rapid heart rate. About 10 minutes later, he had a second syncopal episode for 2 to 3 minutes with more than 20 muscle jerks. On presentation at the emergency department, he was afebrile, blood pressure was 120/59 mm Hg, heart rate was 85 beats per min, respiratory rate was 16 breaths per min, and oxygen saturation was 96% on room air. His cardiac examination revealed normal heart sounds with no murmurs.

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Article Information

Corresponding Author: Asad J. Torabi, MD, Division of Cardiology, Krannert Institute of Cardiology at Indiana University School of Medicine, 1800 N Capital Ave, Indianapolis, IN 46202 (ajtorabi@iupui.edu).

Published Online: June 8, 2022. doi:10.1001/jamacardio.2022.1313

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank Jeffrey Mossler, MD, Indiana University School of Medicine, Indianapolis, for his assistance in reviewing the manuscript; he did not receive financial compensation for his contribution. We also the patient for granting permission to publish this information.

References

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Kawada S , Morita H , Antzelevitch C , et al. Shanghai score system for diagnosis of Brugada syndrome: validation of the score system and system and reclassification of the patients. JACC Clin Electrophysiol. 2018;4(6):724-730. doi:10.1016/j.jacep.2018.02.009 PubMed Google Scholar Crossref

Kusumoto FM , Bailey KR , Chaouki AS , et al. Systematic review for the 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2018;15(10):e253-e274. doi:10.1016/j.hrthm.2017.10.037 PubMed Google Scholar Crossref

Peterson PN , Greenlee RT , Go AS , et al. Comparison of inappropriate shocks and other health outcomes between single—and dual-chamber implantable cardioverter-defibrillators for primary prevention of sudden cardiac death: results from the cardiovascular research network longitudinal study of implantable cardioverter-defibrillators. J Am Heart Assoc. 2017;6(11):e006937. doi:10.1161/JAHA.117.006937 PubMed Google Scholar Crossref

Knops RE , Olde Nordkamp LRA , Delnoy PHM , et al; PRAETORIAN Investigators. Subcutaneous or transvenous defibrillator therapy. N Engl J Med. 2020;383(6):526-536. doi:10.1056/NEJMoa1915932 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.