A patient in their 60s experienced a several-month history of recurrent dizziness and light-headedness. The spells were occasionally preceded by palpitation, nausea, and coning of the visual fields, prompting the patient to sit down. On the day of admission, the patient had an episode of frank syncope resulting in facial contusion. By the time of arrival to the emergency department, full consciousness was regained without postictal symptoms.
On presentation, the heart rate was 88 beats/min and slightly irregular, and the blood pressure was 138/84 mm Hg. Except for obesity and a distant first heart sound, findings of physical examination and results of routine blood tests, including electrolyte, thyrotropin, and cardiac troponin levels, were normal. The 12-lead electrocardiogram (ECG) is presented in the Figure, A. A subsequent echocardiogram showed moderate left ventricular hypertrophy without wall motion abnormalities. All chamber sizes, including the left atrial transverse diameter and left atrial volume index, were within normal limits. The estimated left ventricular ejection fraction was 60% to 65%. Because of dysrhythmia, evaluation of diastolic function was inconclusive.
Please finish quiz first before checking answer.
Read the answer below and download your certificate.
Read the discussion below and retake the quiz.
Atrial fibrillation is the most common sustained arrhythmia. Its prevalence increases with age and in the presence of structural heart disease.4 The most dreaded consequence of atrial fibrillation is stroke, which is often devastating. Unfortunately, even patients with silent, unrecognized atrial fibrillation are at risk of stroke.4,5 Today, prolonged ECG monitoring of patients with cryptogenic stroke (ie, those patients for whom detailed evaluation did not find a cause for the cerebrovascular event) is emerging as standard of care.6 There is less robust evidence that widespread monitoring of older adult patients with clinical risk factors but no prior cerebrovascular events is a cost-effective approach.7 In such patients, recognizing ECG risk factors for atrial fibrillation appears to be a crucial task.
Sign in to take quiz and track your certificates
JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC
CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Laszlo Littmann, MD, PhD, Department of Internal Medicine, Atrium Health Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232 (email@example.com).
Published Online: August 8, 2022. doi:10.1001/jamainternmed.2022.3304
Conflict of Interest Disclosures: None reported.
You currently have no searches saved.
You currently have no courses saved.