A 21-Year-Old Woman Is Evaluated for Syncope

A 21-year-old woman is evaluated for syncope.  She has had recurrent episodes of syncope since her mid-teens.  The first episode happened when she was having blood drawn for a test.  She has also passed out several times while standing in a crowded church.  The syncope is typically preceded by a feeling of warmth, lightheadedness, diaphoresis, and nausea.  During one episode, the patient had a minor head injury and facial laceration.  Her medical history is otherwise insignificant.  She takes no medications and uses no illicit drugs.  Blood pressure is 122/76 mm Hg supine and 125/80 mm Hg after 2 minutes of standing.  Pulse is 72/min and regular.  Physical examination is unremarkable.  ECG shows normal sinus rhythm with no significant abnormalities.  Long-term ECG monitoring is most likely to show which of the following immediately preceding and during the syncopal episode?

A) Atrial fibrillation
B) Bradycardia and sinus arrest
C) Sinus tachycardia
D) Third-degree atrioventricular block
E) Ventricular tachycardia

Correct Answer:

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