Elusive cardiac dysrhythmia in high-risk syncope

Area of Science:

• Cardiology
• Emergency Medicine
• Electrophysiology

Background:

• Syncope presentations in the emergency department (ED) range widely in severity.
• Older patients face a higher risk of cardiac etiologies for syncope.
• Ventricular standstill, a rare cause of syncope, necessitates immediate intervention to avert sudden cardiac arrest.

Observation:

• A 70-year-old male presented with dizziness and convulsive syncope.
• Initial electrocardiogram (ECG) revealed a right bundle branch block.
• The patient subsequently developed ventricular standstill and intermittent high-grade atrioventricular (AV) block in the ED.

Findings:

• The patient required transfer to the intensive care unit (ICU).
• Pacemaker implantation was successfully performed.
• The case highlights a critical, albeit rare, presentation of cardiac dysrhythmia.

Implications:

• Maintaining a high index of suspicion for dysrhythmias is vital for patients with high-risk syncope in the ED.
• Early recognition and management of life-threatening arrhythmias can improve patient outcomes.
• This case underscores the importance of continuous cardiac monitoring in the ED for selected patients.