Thank you to our PD emeritus Dr. Marshall Wolf & @tmmeade1 for kicking off the week with a case of syncope yesterday!
The 💰 is in the 🗣️!
1. Is this true syncope? Transient LOC + spontaneous and rapid recovery
2. How worried 😱 are you for 💔 etiology? Any ❤️ disease, new chest pain/palpitations, exertional or supine syncope, FHx sudden cardiac death, abnormal VS or ECG should set off 🚨
...May be reassured by syncope stable x years, with clear prodrome & trigger, in a younger individual (<40 y/o)
🤔 In thinking about worrisome etiologies, recurrent syncope less likely to be tamponade, dissection, ACS, PE but arrhythmia🔌💓 still on the table!
#TheBrighamFamily looooooooves a good TTE!
But consider ROMEO score (shout out to @tony_breu and @thecurbsiders) - a score of zero 99.5% sensitive for a normal TTE, so may not be needed in all comers with syncope!
In this case, our patient had recurrent syncope and recent event monitor:
Dropped beats concerning for Mobitz I vs. II - 2:1 block makes it challenging to distinguish!
While Mobitz II confers worse prognosis and ⬆️ progression to CHB, symptoms/syncope + 2nd degree block = class 1 PPM indication!
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