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European Cardiac Arrhythmia Association
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How would you manage this patient ?

Case report

This  24 year old man complained of syncope.
Personal and familial history: unremarkable Physical examination  and work-up  showed no evidence of heart disease.
The 12 lead ECG is shown in figure

What is your interpretation?
Which test might be of help?
How would you tell ?

How would you manage this patient?

Figure: 12 lead ECG



see our  comments click here



The 12 lead  ECG shows an early Repolarization pattern

Notch on the S wave
J point elevation of >1mm (0.1mV) on 2 consecutive leads

This pattern was found with a higher incidence in pts who suffered a cardiac arrest related
to idiopathic VF.



Management

The clinical work-up including  echocardiogram concluded  that the patient had a normal heart. There was no family history of sudden death.
The patient underwent a head-up tilt test which was positive. The diagnostic of cardiogenic vaso-vagal syncope was likely.
The patient was discharged. The diagnosis of ER pattern differs from that of the ER syndrome. We did not inform the patient to avoid unecessary anxiety1 and reassured him

1. Levy and Sbragia. J of Interventional Electrophysiology 2011;32:181-6

Your comments will be welcome!



02/12/2011 , Samuel Levy , Aix Marseille University
I believe it was a VASIS 1 as the response was mixed with bradycardia associated to hypotension and pre-syncope.
20/11/2011 , Fiore Candelmo , A.O. Moscati Syncope Unit Avellino Italy
You wrote that HUTT was positive: what was the VASIS class ? Thanks
03/10/2011 , Samuel Levy , Aix-Marseille Université
I agree with the interpretation and with the management of this patient


ECAS Heartrhythm © 2011
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