A 42-Year-Old Man Comes to the Emergency Department Due to an Episode

question 394

Multiple Choice

A 42-year-old man comes to the emergency department due to an episode of syncope.  He was standing in his kitchen this morning when he felt palpitations for about 3 seconds; the next thing he remembers is waking up on the floor.  The patient has had intermittent palpitations for the last few weeks, sometimes with associated lightheadedness.  He has no significant medical history other than chronic lower back pain that began following a fall from a ladder 3 years ago.  The patient fractured several lumbar vertebrae in that fall and required a surgical lumbar fusion.  His back pain was uncontrolled with conservative measures, and he has been treated with escalating doses of methadone for the past year.  He does not smoke or drink alcohol.  The patient has a remote history of intravenous heroin abuse but has not used it for 20 years.  He has no family history of early-onset heart disease, blood clots, or sudden death.  Blood pressure is 120/70 mm Hg when supine and 125/75 mm Hg when standing.  Physical examination is unremarkable.  Which of the following ECG findings is most likely in this patient?

• A)Atrioventricular block
• B)Deep Q waves
• C)QT interval prolongation
• D)Sinus pauses
• E)Ventricular preexcitation

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Definitions:

Direct Infant Contact

Physical interaction between a caregiver and an infant, important for bonding, emotional, and neurological development.

Cultures

The shared beliefs, practices, norms, and values of a group of people that are passed from generation to generation.

Shy

The feeling or behavior of feeling nervous or timid in the presence of others, often leading to withdrawal.

Inhibited

Restrained, held back, or suppressed, often in context of emotions, behaviors, or reactions.