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Hidden Fatal ECG Manifestations

To identify the key insights or developments described in this article
1 Credit CME

A 50-year-old male patient was brought to the emergency department (ED) due to syncope 30 minutes before admission. The patient reported experiencing palpitation and amaurosis, followed by loss of consciousness that lasted for several minutes, without any preceding body position change, cough, chest pain, or shortness of breath. The patient experienced a previous episode of syncope 1 month prior. The patient’s medical history indicated only diabetes, which was well controlled with medication.

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A 50-year-old male patient was brought to the emergency department (ED) due to syncope 30 minutes before admission. The patient reported experiencing palpitation and amaurosis, followed by loss of consciousness that lasted for several minutes, without any preceding body position change, cough, chest pain, or shortness of breath. The patient experienced a previous episode of syncope 1 month prior. The patient’s medical history indicated only diabetes, which was well controlled with medication.

On admission, the patient was alert and asymptomatic, with vital signs that included a blood pressure of 125/96 mm Hg, pulse rate of 81 beats/min, respiratory rate of 18 breaths/min, and oxygen saturation of 99% under ambient air. Physical examination showed normal results; laboratory test results, including blood glucose, electrolytes, D-dimer, troponin I (<0.01 ng/mL), and N-terminal pro–B-type natriuretic peptide, indicated no abnormalities. Electrocardiogram results after admission were also normal. Moreover, transthoracic echocardiography results were normal, with a left ventricular ejection fraction of 58%.

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Article Information

Corresponding Author: Hailei Liu, MD, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300#, Guangzhou Road, Nanjing, 210029, People’s Republic of China (liuhailei@njmu.edu.cn).

Published Online: September 18, 2023. doi:10.1001/jamainternmed.2023.2850

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

References
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Shen  WK , Sheldon  RS , Benditt  DG ,  et al; Writing Committee Members.  2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society.   Heart Rhythm. 2017;14(8):e155-e217. doi:10.1016/j.hrthm.2017.03.004 PubMedGoogle ScholarCrossref
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