Rhythm Nation returns for another installment of critical analysis of the ECGs seen at King’s County. Onwards!
87 year-old male, history of HTN, dyslipidemia, DM, Stage III CKD, Prostate cancer s/p radiation presents with syncope.
Two weeks ago, he noted urinary frequency and saw a doctor in Brooklyn who gave him tamsulosin. While taking this, he felt lightheaded. He stopped the medication 3 days ago, but the lightheadedness continued. This morning, he went to pick up the newspaper, felt lightheaded, and fell backwards. He was saved from any injury by his home health aide who is at bedside. The patient has no symptoms presently.
ROS: Denies recent illness, tongue biting, or micturition during episode, as well as seizure, fevers, chills, chest pain or dyspnea in the last 2 weeks, abdominal pain, N/V/D, or changes in BM
PMH: No history of coronary artery disease, history of PE or DVT
SH: Lives alone in Brooklyn, home health aide visits daily from 9a-5p
FH: Father died of MI at 57
Meds: Atorvastatin, metformin, lisinopril, tamsulosin
Vitals: 97.8, 79, 198/124, 18, 100% on RA, not orthostatic
Gen: Well appearing, awake, alert, NAD, non-diaphoretic
HEENT: NCAT, EOMI, no conjunctival pallor
CV: Irregular rhythm, no m/r/g, good pulses in b/l UE, LE
Resp: CTAB no w/r/r, good effort
Abd: Soft, NTND, +BS, no masses, no HSM
Ext: Nl ROM, inspection in b/l UE, LE
Skin: No rashes or lesions
Neuro: CN intact, intact motor, sensation in b/l UE, LE, able to stand without ataxia
Discuss the ECG findings. What is the pathophysiology? What complications may arise? How would you manage this patient?