Syncope in a Young Man

Abstract

A 31-year-old Bangladeshi man with no medical history of note was brought into the ED by his friends. He had an episode of syncope while driving. His vital signs on arrival were blood pressure, 116/70 mmHg; respiratory rate, 16/min; oxygen saturation, 100% on room air, and temperature, 36°C. The patient was slightly drowsy but arousable. Physical examination was unremarkable. His blood glucose level was 8.9 mmol/L. ECG was performed on arrival (Figure 1). Shortly after arrival, the patient developed two episodes of tonic-clonic seizures that stopped spontaneously. He was immediately intubated for airway protection. Repeat ECG showed atrial fibrillation with ST depression in anterolateral leads (Figure 2).A few minutes post-intubation, he developed two episodes of ventricular fibrillation (VF), both of which responded to biphasic defibrillation of 150 J. Slow intravenous bolus of 150 mg amiodarone (cordarone; Wyeth Pharmaceuticals Inc.