Syncope, Paresthesias, and Weakness in a 35-year-old Man

A 35-year-old man presents to the emergency department complaining of syncope. He denies any preceding chest pain, palpitations or trouble breathing, and states he did not injure himself other than a bump on his forehead. On arrival he says he has a mild headache but has not vomited and the headache is improving. He mentions that for the past few days he has had a “pins-and-needles” sensation in both hands and has experienced generalized weakness, but has been able to function. He is otherwise healthy and does not routinely see a doctor.

Physical examination is unremarkable except for a blood pressure measurement of 189/122 mm Hg and a contusion just above his eyebrow. His lungs are clear and he has no cardiac murmur. He also has a normal neurologic exam including short-term memory so a CT of the head is not ordered.

Blood is sent for routine laboratory work up and an ECG is done; the tracing is shown in the Figure.

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 â–º What ECG findings should you look for in a tracing for a patient who has fainted?

 â–º What does this ECG suggest?

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